Jornal Brasileiro de Patologia e Medicina Laboratorial
On-line version ISSN 1678-4774
GONCALVES, Cássia Cristina Alves; RIBEIRO, Luiz Claudio Pereira; SA, Carlos Alberto Morais de and PUCCIONI-SOHLER, Marzia. Laboratorial diagnosis of HTLV-I associated myelopathy: methods for the cerebrospinal fluid analysis. J. Bras. Patol. Med. Lab. [online]. 2009, vol.45, n.2, pp.99-110. ISSN 1678-4774. http://dx.doi.org/10.1590/S1676-24442009000200003.
The human T-cell lymphotropic virus type I (HTLV-I) may cause HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP), an incapacitating chronic inflammatory disease of the spinal cord. The detection of IgG anti-HTLV-I antibodies in the serum and cerebrospinal fluid (CSF) has been an important parameter for the laboratorial diagnosis of HAM/TSP. OBJECTIVE: critical evaluation of the methods applied to detect the presence and intrathecal production of total antibodies and anti-HTLV-I in the CSF for the diagnosis of HAM/TSP. METHODS: We performed a systematic review of medical articles by using the key words: "cerebrospinal fluid, intrathecal synthesis of antibodies, HTLV-I associated myelopathy, HTLV-I, HAM/TSP". The used databases included: PubMed, Lilacs, Medline and Cochrane Library. RESULTS: A total of 14 articles were selected: five studies were related to the presence of specific IgG antibody in the CSF and nine studied the intrathecal synthesis of total antibodies (IgG or IgG/IgA/IgM) and specific anti-HTLV-I (IgG or IgM). DISCUSSION: The isolated study of the presence of IgG antibody anti-HTLV-I in the CSF does not show the fraction produced in the central nervous system, which represents low specificity (40%) for the diagnosis of HAM/TSP. The demonstration of the intrathecal synthesis of IgG anti-HTLV-I antibodies is more relevant due to its high specificity (89%) and sensibility (83%). According to Reiber & Felgenhauer (1987), the index IgG anti-HTLV-I, which is based on ELISA test with simultaneous CSF and serum analysis, stands out from the other methods applied to evaluate the intrathecal synthesis of specific antibody. Other studies use small samples and do not demonstrate the sensibility and specificity of the test in the CSF. Only one study shows statistical analysis. CONCLUSION: The immunological diagnosis of the CSF in HAM/TSP requires the standardization of methods, which should be based on tests of high sensibility and specificity.
Keywords : Cerebrospinal fluid; Intrathecal synthesis of antibodies; HTLV-I; HTLV-I index; HAM/TSP.