HTLV-1 and myelopathy in Salvador (Northeastern Brazil): a case control study

Lessa, Ines; Moraes, Dilcineia; Moura, Luciana; Melo, Aílton

doi:10.1590/S0004-282X1993000400004

Abstracts

The principal aim of the study was to determine the degree of association between cerebrospinal fluid (CSF) that is positive for HTLV-1 and myelopathy in Salvador, Brazil. From the same hospital, twenty-eight cases of myelopathy and twenty-eight cases showing no neurological disorder were studied using blind selection matched 1:1 by age and sex. The twenty-eight pairs underwent HTLV-1 serology tests. In those with a positive result, anti-HTLV-1 antibodies were investigated in the CSF. The ELISA method was used, complemented by the Western-blot test. Myelopathy was considered associated with HTLV-1 only when the CSF was positive indicating neurotropism of the virus. The mean age of the cases was 44.6 ± 15.6 years and the control group was 43.5 ± 16.0 (p>0.05). An OR of 9.0 was detected with a reability interval (95%) of 1.652-48.866 and chi-square significant at the 0.02 level. Despite a strong degree of association and considering the low level of precision, there is a need for analytical studies with larger samples which besides improving the precision will allow for greater control of the confounding variables.

HTDV-1; retrovirus; analytical studies; tropical spastic paraparesis; Brazil

Procurou-se determinar a magnitude da associação entre positividade do líquido cefalorraqueano (LCR) para HTLV-1 e mielopatias em Salvador. Foram estudados 28 casos de mielopatias e 28 casos sem doença neurológica, todos procedentes de um único hospital. A seleção foi de modo cego, com pareamento 1:1, por idade e sexo. Os 28 pares realizaram sorologia para HTLV-1 e, nos casos com mielopatia, foram pesquisados anticorpos para HTLV-1 no LCR. Na investigação dos anticorpos foram utilizados os métodos ELISA e Western-blot. Os casos tiveram média de idade de 44,6 ± 15,6 anos e os controles de 43,5 ± 16,0 (p>0,05). Observamos um OR=9,0 com intervalo de confiança 95% de 1,652-48,866 e qui-quadrado significante a 0,02. Apesar do grande nível de associação encontrado, estudos analíticos com associações maisi amplas são necessários com o objetivo de melhorar a precisão e o controle de variáveis intervenientes.

HTLV-1; retrovirus; estudo analítico; paraparesia espástica tropical; Brasil

HTLV-1 and myelopathy in Salvador (Northeastern Brazil): a case control study

Estudo caso-controle de mielopatias por HTLV-1 em Salvador

Ines Lessa^I; Dilcineia Moraes^II; Luciana Moura; Aílton Melo^II

^IDepartment of Preventive Medicine. Federal University of Bahia (UFBA), Salvador

^IIDepartment of Neuropsychiatry. Federal University of Bahia (UFBA), Salvador

SUMMARY

The principal aim of the study was to determine the degree of association between cerebrospinal fluid (CSF) that is positive for HTLV-1 and myelopathy in Salvador, Brazil. From the same hospital, twenty-eight cases of myelopathy and twenty-eight cases showing no neurological disorder were studied using blind selection matched 1:1 by age and sex. The twenty-eight pairs underwent HTLV-1 serology tests. In those with a positive result, anti-HTLV-1 antibodies were investigated in the CSF. The ELISA method was used, complemented by the Western-blot test. Myelopathy was considered associated with HTLV-1 only when the CSF was positive indicating neurotropism of the virus. The mean age of the cases was 44.6 ± 15.6 years and the control group was 43.5 ± 16.0 (p>0.05). An OR of 9.0 was detected with a reability interval (95%) of 1.652-48.866 and chi-square significant at the 0.02 level. Despite a strong degree of association and considering the low level of precision, there is a need for analytical studies with larger samples which besides improving the precision will allow for greater control of the confounding variables.

Key words: HTDV-1, retrovirus, analytical studies, tropical spastic paraparesis, Brazil.

RESUMO

Procurou-se determinar a magnitude da associação entre positividade do líquido cefalorraqueano (LCR) para HTLV-1 e mielopatias em Salvador. Foram estudados 28 casos de mielopatias e 28 casos sem doença neurológica, todos procedentes de um único hospital. A seleção foi de modo cego, com pareamento 1:1, por idade e sexo. Os 28 pares realizaram sorologia para HTLV-1 e, nos casos com mielopatia, foram pesquisados anticorpos para HTLV-1 no LCR. Na investigação dos anticorpos foram utilizados os métodos ELISA e Western-blot. Os casos tiveram média de idade de 44,6 ± 15,6 anos e os controles de 43,5 ± 16,0 (p>0,05). Observamos um OR=9,0 com intervalo de confiança 95% de 1,652-48,866 e qui-quadrado significante a 0,02. Apesar do grande nível de associação encontrado, estudos analíticos com associações maisi amplas são necessários com o objetivo de melhorar a precisão e o controle de variáveis intervenientes.

Palavras-chave: HTLV-1, retrovirus, estudo analítico, paraparesia espástica tropical, Brasil.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Aceite: 13-maio-1993.

Dr. Ailton Melo Departamento de Neuropsiquiatria, Faculdade de Medicina, UFBA - Av. Reitor Miguel Calmon s/n - 40110-100 Salvador BA - Brasil. Fax 55.71.2458562.

1. Akizuki S, Nakazato O, Higuchi Y, Tanabe K, Setohushi M, Yoshida S, Miyasaki Y, Yamamoto S, Sudou S, Sannomiya K, Okajima T. Necropsy findings in HTLV-1 associated myelopathy. Lancet 1987, 1:156-157.
2. Arango C, Concha M, Zaninovic V, Corral R, Biojo R, Borrero I, Rodgers-Jodgers-Johnson P, Mora C, Garruto RM, Gibbs Jr CJ. Epidemiology of tropical spastic paraparesis in Colombia and associated HTLV-1 infection. Ann Neurol 1988, 23(Suppl) :S161-S165.
3. Bartholomew C, Cleghorr F, Charles W, Ratan P, Roberts L, Maharaj K, Jankey N, Dais-ley H, Hanchard B, Blattner W. HTLV-1 and tropical spastic paraparesis. Lancet 1986, 2:99-100.
4. Castro LAM, Chaves CJ, Callegaro D, Nobrega JPS, Scaff M. HTLV-1 associated myelopathy in Brazil: a preliminary report. Arq Neuropsiquiatr 1989, 47:501-502.
5. Cortes E, Detels R, Aboulafia D, Li XL, Maudgil T, Alam M, Bonecker C, Gonzaga A, Oyafuso L, Tondo M. HIV-1, HIV-2 and HTLV-1 infection in high risk groups in Brazil. N Engl J Med 1989, 320:953-958.
6. Costa CMC, Vale OC, Goubau P, Desmyter J, Carton H. HTLV-1 and tropical spastic paraparesis in Fortaleza (Northeastern Brazil). J Trop Geogr Neurol 1991, 1:45-48.
7. Gessain A, Barin F, Vernant JC, Gout O, Maurs L, Calender A, De Thé G. Antibodies to human T-lymphotropic virus type-1 in patients with tropical spastic paraparesis. Lancet 1985, 2:407-408.
8. Gessain A, Francis H, Soran T, Giordano C, Akani F, Pignemal M, Caudie, C, Malone G, Essex M, De Thé G. HTLV-1 and tropical spastic paraparesis in Africa. Lancet 1986, 2:698.
9. Grimaldi LM, Roos RP, Devare SG, Casey JM, Maruo Y, Hamada T, Tashiro K. HTLV-1 associated myelopathy: oligoclonal immunoglobulin G bands contain anti HTLV-1 p24 antibody. Ann Neurol 1988, 24:727-731.
10. Harrington WJ Jr, Sheremata WA, Snodgrass SR. Emerson S, Phillips S, Berger JR. Tropical spastic paraparesis/HTLV-1 associated myelopathy treatment with an anabolic steroid: danazol. AIDS Res Hum Retrov 1991, 7:1031-1034.
11. Melo A, Moura L, Meireles A, Costa G. Danazol: a new perspective in the treatment of HTLV-1 associated myelopathy (preliminary report) Arq Neuropsiquiatr 1902, 50:402-403.
12. Nakauchi CM, Macedo JE, Maruyama K, Kanzaki LI, Macedo JE, Azevedo VN, Casseb JS. Prevalence to human T-cell leukemia virus type 1 (HTLV-1) antibody among populations living in the Amazon region of Brazil: preliminary report. Mem Inst Osw Cruz 1990, 85:29.
13. Oliveira MSP, Matutes E, Famades LC. Adult T-cell leukemia/lymphoma in Brazil and its relation to HTLV-1. Lancet 1990, 336:987-990.
14. Osame M, Usuku K, Izumo S, Ijichi N, Amitani H, Igata A, Matsumoto M, Tara M. HTLV-1 associated myelopathy: a new clinical entity. Lancet 1986, 1:1031-1032.
15. Osame M, Igata A, Matsumoto M, Kohka M, Usuku K, Izumo S. HTLV-1 associated myelopathy: treatment trials, retrospective survey and clinical and laboratory findings. Hematol Rev 1990, 3:271-284.
16. Osame M, McArthur JC. Neurologic manifestations of infection with human T cell lym-photropic virus type 1. In: Asbury AK, McKhann GM, McDonald WI (eds). Diseases of the nervous system: clinical neurobiology. Philadelphia: Saunders, 1992, p 1331-1339.
17. Ramiandrisoa H, Dermas M, Giordano C, N'Diaye IP, Grunitzky EK, Kabone J, Verdier M, Diop P, N'Diaye M, Denis F. Human retroviruses HTLV-1, HIV-2, HIV-3 and neurological disease in West-Africa. J Trop Geogr Neurol 1991, 1:39-44.
18. Rodjers-Johnson P, Gajdusek DC, Morgan OSTC, Zaninovic V, Sarin P, Graham DS. HTLV-1 and HTLV-3 antibodies in tropical spastic paraparesis. Lancet 1985, 2:1247-1248.
19. Rodgerst-Johnson P, Morgan OSTC, Mora C, Sarin P, Ceroni M, Piccardo P, Garruto RM, Gibbs CJ Jr, Gajdusek DC. The role of HTLV-1 in tropical spastic paraparesis in Jamaica. Ann Neurol 1988, 23(Suppl) :S121-S126.
20. Roman GC, Shoenheng BS, Maddeu DL. Human T-lymphotropic virus type-1 antibodies in the serum of patients with tropical spastic paraparesis in the Seychelles. Arch Neurol 1987, 44:605-607.
21. Roman GC, Spencer PS, Path MRC, Shoenheng BS, Hugon J, Ludolph A, Rodgers-Johnson P, Osuntokun BO, Shamlaye CF. Tropical spastic paraparesis in the Seychelles Islands a clinical and case-control neuroepidemiology study. Neurology 1987, 37:1323-1328.
22. Spina-França A, Livramento JA, Machado LR, Gomes HR, Vianna LS, Castro LHM, Nóbrega JPS, Bacheschi LA. HTLV-1 antibodies in serum and cerebrospinal fluid in tropical spastic paraparesis in Brazil. Arq Neuropsiquiatr 1990, 48:441-447.
23. Vernant JC, Maurs L, Gessain A, Barin F, Gout O, Delaporte JM, Sanhadjl K, Buisson G, De Thé G. Endemic tropical spastic paraparesis associated with human T-cell leukemia virus type-1: a clinical and neuroepidemiological study of 25 cases. Ann Neurol 1987, 21: 123-130.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Nov 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Akizuki S, Nakazato O, Higuchi Y, Tanabe K, Setohushi M, Yoshida S, Miyasaki Y, Yamamoto S, Sudou S, Sannomiya K, Okajima T. Necropsy findings in HTLV-1 associated myelopathy. Lancet 1987, 1:156-157.

[2] 2. Arango C, Concha M, Zaninovic V, Corral R, Biojo R, Borrero I, Rodgers-Jodgers-Johnson P, Mora C, Garruto RM, Gibbs Jr CJ. Epidemiology of tropical spastic paraparesis in Colombia and associated HTLV-1 infection. Ann Neurol 1988, 23(Suppl) :S161-S165.

[3] 3. Bartholomew C, Cleghorr F, Charles W, Ratan P, Roberts L, Maharaj K, Jankey N, Dais-ley H, Hanchard B, Blattner W. HTLV-1 and tropical spastic paraparesis. Lancet 1986, 2:99-100.

[4] 4. Castro LAM, Chaves CJ, Callegaro D, Nobrega JPS, Scaff M. HTLV-1 associated myelopathy in Brazil: a preliminary report. Arq Neuropsiquiatr 1989, 47:501-502.

[5] 5. Cortes E, Detels R, Aboulafia D, Li XL, Maudgil T, Alam M, Bonecker C, Gonzaga A, Oyafuso L, Tondo M. HIV-1, HIV-2 and HTLV-1 infection in high risk groups in Brazil. N Engl J Med 1989, 320:953-958.

[6] 6. Costa CMC, Vale OC, Goubau P, Desmyter J, Carton H. HTLV-1 and tropical spastic paraparesis in Fortaleza (Northeastern Brazil). J Trop Geogr Neurol 1991, 1:45-48.

[7] 7. Gessain A, Barin F, Vernant JC, Gout O, Maurs L, Calender A, De Thé G. Antibodies to human T-lymphotropic virus type-1 in patients with tropical spastic paraparesis. Lancet 1985, 2:407-408.

[8] 8. Gessain A, Francis H, Soran T, Giordano C, Akani F, Pignemal M, Caudie, C, Malone G, Essex M, De Thé G. HTLV-1 and tropical spastic paraparesis in Africa. Lancet 1986, 2:698.

[9] 9. Grimaldi LM, Roos RP, Devare SG, Casey JM, Maruo Y, Hamada T, Tashiro K. HTLV-1 associated myelopathy: oligoclonal immunoglobulin G bands contain anti HTLV-1 p24 antibody. Ann Neurol 1988, 24:727-731.

[10] 10. Harrington WJ Jr, Sheremata WA, Snodgrass SR. Emerson S, Phillips S, Berger JR. Tropical spastic paraparesis/HTLV-1 associated myelopathy treatment with an anabolic steroid: danazol. AIDS Res Hum Retrov 1991, 7:1031-1034.

[11] 11. Melo A, Moura L, Meireles A, Costa G. Danazol: a new perspective in the treatment of HTLV-1 associated myelopathy (preliminary report) Arq Neuropsiquiatr 1902, 50:402-403.

[12] 12. Nakauchi CM, Macedo JE, Maruyama K, Kanzaki LI, Macedo JE, Azevedo VN, Casseb JS. Prevalence to human T-cell leukemia virus type 1 (HTLV-1) antibody among populations living in the Amazon region of Brazil: preliminary report. Mem Inst Osw Cruz 1990, 85:29.

[13] 13. Oliveira MSP, Matutes E, Famades LC. Adult T-cell leukemia/lymphoma in Brazil and its relation to HTLV-1. Lancet 1990, 336:987-990.

[14] 14. Osame M, Usuku K, Izumo S, Ijichi N, Amitani H, Igata A, Matsumoto M, Tara M. HTLV-1 associated myelopathy: a new clinical entity. Lancet 1986, 1:1031-1032.

[15] 15. Osame M, Igata A, Matsumoto M, Kohka M, Usuku K, Izumo S. HTLV-1 associated myelopathy: treatment trials, retrospective survey and clinical and laboratory findings. Hematol Rev 1990, 3:271-284.

[16] 16. Osame M, McArthur JC. Neurologic manifestations of infection with human T cell lym-photropic virus type 1. In: Asbury AK, McKhann GM, McDonald WI (eds). Diseases of the nervous system: clinical neurobiology. Philadelphia: Saunders, 1992, p 1331-1339.

[17] 17. Ramiandrisoa H, Dermas M, Giordano C, N'Diaye IP, Grunitzky EK, Kabone J, Verdier M, Diop P, N'Diaye M, Denis F. Human retroviruses HTLV-1, HIV-2, HIV-3 and neurological disease in West-Africa. J Trop Geogr Neurol 1991, 1:39-44.

[18] 18. Rodjers-Johnson P, Gajdusek DC, Morgan OSTC, Zaninovic V, Sarin P, Graham DS. HTLV-1 and HTLV-3 antibodies in tropical spastic paraparesis. Lancet 1985, 2:1247-1248.

[19] 19. Rodgerst-Johnson P, Morgan OSTC, Mora C, Sarin P, Ceroni M, Piccardo P, Garruto RM, Gibbs CJ Jr, Gajdusek DC. The role of HTLV-1 in tropical spastic paraparesis in Jamaica. Ann Neurol 1988, 23(Suppl) :S121-S126.

[20] 20. Roman GC, Shoenheng BS, Maddeu DL. Human T-lymphotropic virus type-1 antibodies in the serum of patients with tropical spastic paraparesis in the Seychelles. Arch Neurol 1987, 44:605-607.

[21] 21. Roman GC, Spencer PS, Path MRC, Shoenheng BS, Hugon J, Ludolph A, Rodgers-Johnson P, Osuntokun BO, Shamlaye CF. Tropical spastic paraparesis in the Seychelles Islands a clinical and case-control neuroepidemiology study. Neurology 1987, 37:1323-1328.

[22] 22. Spina-França A, Livramento JA, Machado LR, Gomes HR, Vianna LS, Castro LHM, Nóbrega JPS, Bacheschi LA. HTLV-1 antibodies in serum and cerebrospinal fluid in tropical spastic paraparesis in Brazil. Arq Neuropsiquiatr 1990, 48:441-447.

[23] 23. Vernant JC, Maurs L, Gessain A, Barin F, Gout O, Delaporte JM, Sanhadjl K, Buisson G, De Thé G. Endemic tropical spastic paraparesis associated with human T-cell leukemia virus type-1: a clinical and neuroepidemiological study of 25 cases. Ann Neurol 1987, 21: 123-130.