Mielopatias por HTLV-1 na cidade de Salvador, Bahia

Melo, Ailton; Gomes, Irenio; Mattos, Kilma

doi:10.1590/S0004-282X1994000300006

Resumos

Paraparesia espástica progressiva associada a HTLV-1 constitui-se em uma patologia com características endêmicas em várias regiões do Brasil. Em Salvador, 102 pacientes com mielopatias de diversas etiologias foram triados para HTLV-I/II com ELISA e Western blot em quatro hospitais gerais que assistem a população de baixa renda. Foram encontrados 36 pacientes com mielopatia associada a HTLV-I/II, o que está de acordo com a elevada prevalência dessa patologia em Salvador. Todos os pacientes com infecção pelo HTLV-I/ II apresentavam paraparesia espástica progressiva, bexiga neurogênica associada, a graus variáveis de comprometimento sensitivo superficial e/ou profundo e síndrome do neurônio motor inferior. O exame de LCR mostrou pleocitose linfocitária com aumento moderado de gama-globulinas e a ressonância magnética mostrou graus variáveis de lesões periventriculares e subcorticais associadas ou não a atrofia da medula espinal torácica. O exame neurológico e os dados de ressonância magnética sugerem que os pacientes com comprometimento neurológico por HTLV-I podem estar acometidos por graus variáveis de leucoencefalomieloneuropatia.

HTLV-I; paraparesia espástica tropical; TSP HAM; leucoencefalomieloneuropatia

Chronic myelopathy associated with human T-lymphotropic virus type I (HTLV-I) has been described in several endemic areas in Brazil. In Salvador, 102 patients with myelopathy were screened for HTLV-I/II by ELISA and Western blot assays. We found 36 patients with HTLV-I/II associated myelopathy confirming the high prevalence of HAM in Salvador. The initial complaint of our patients were urinary urgency, back pain and progressive unsteadiness on walking. On examination all of them had a spastic paraparesis, variable degrees of lower motor neuron syndrome, deep and superficial sensitive syndrome. MRI analysis revealed lesions in the periventricular white matter in addition to atrophy of the thoracic spinal cord. Clinical and magnetic resonance findings reveal that the inflammatory lesions of HAM involve not only the spinal cord but also the brain and peripheral nervous system.

HTLV-I; myelopathy; tropical spastic paraparesis; TSP; HAM; leukoencephalomyeloneuropathy

Mielopatias por HTLV-1 na cidade de Salvador, Bahia

HTLV-I associated myelopathy in the city of Salvador, Bahia (Brazil)

Ailton Melo; Irenio Gomes; Kilma Mattos

Unidade de Neuroinfectologia, Universidade Federal da Bahia (UFBA)

RESUMO

Paraparesia espástica progressiva associada a HTLV-1 constitui-se em uma patologia com características endêmicas em várias regiões do Brasil. Em Salvador, 102 pacientes com mielopatias de diversas etiologias foram triados para HTLV-I/II com ELISA e Western blot em quatro hospitais gerais que assistem a população de baixa renda. Foram encontrados 36 pacientes com mielopatia associada a HTLV-I/II, o que está de acordo com a elevada prevalência dessa patologia em Salvador. Todos os pacientes com infecção pelo HTLV-I/ II apresentavam paraparesia espástica progressiva, bexiga neurogênica associada, a graus variáveis de comprometimento sensitivo superficial e/ou profundo e síndrome do neurônio motor inferior. O exame de LCR mostrou pleocitose linfocitária com aumento moderado de gama-globulinas e a ressonância magnética mostrou graus variáveis de lesões periventriculares e subcorticais associadas ou não a atrofia da medula espinal torácica. O exame neurológico e os dados de ressonância magnética sugerem que os pacientes com comprometimento neurológico por HTLV-I podem estar acometidos por graus variáveis de leucoencefalomieloneuropatia.

Palavras-chave: HTLV-I, paraparesia espástica tropical, TSP HAM, leucoencefalomieloneuropatia.

SUMMARY

Chronic myelopathy associated with human T-lymphotropic virus type I (HTLV-I) has been described in several endemic areas in Brazil. In Salvador, 102 patients with myelopathy were screened for HTLV-I/II by ELISA and Western blot assays. We found 36 patients with HTLV-I/II associated myelopathy confirming the high prevalence of HAM in Salvador. The initial complaint of our patients were urinary urgency, back pain and progressive unsteadiness on walking. On examination all of them had a spastic paraparesis, variable degrees of lower motor neuron syndrome, deep and superficial sensitive syndrome. MRI analysis revealed lesions in the periventricular white matter in addition to atrophy of the thoracic spinal cord. Clinical and magnetic resonance findings reveal that the inflammatory lesions of HAM involve not only the spinal cord but also the brain and peripheral nervous system.

Key-words: HTLV-I, myelopathy, tropical spastic paraparesis, TSP, HAM, leukoencephalomyeloneuropathy.

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Aceite: 4-dezembro-1993.

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

1. Akizuki S, Nakazato O, Higuchi Y, Tanabe K, Setoguchi M, Yoshida S, Miyazaki Y, Yamamoto S, Sudou S, Sannomiya K, Okajima T. Necropsy findings in HTLV-I associated myelopathy. Lancet 1987, 1: 156-157.
2. Araújo AQC, Alfonso CR, Schor D, Leite AC, Andrade-Serpa MJ. Clinical and demographic features of HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Rio de Janeiro, Brazil. Acta Neurol Scand 1993, 88: 59-62.
3. Araújo AQC, Alfonso CR, Schor D, Andrade-Serpa MJ. Spastic paraparesis of obscure origin: a case control study of HTLV-I positive and negative patients from Rio de Janeiro, Brazil. J Neurol Sci 1993, 116: 165-169.
4. Bhigjee Al, Bill PLA, Wiley CA, Windsor IM, Mathias DA, Amenomori T,Wachsman W, Moorhouse D. Peripheral nerve lesions in HTLV-I associated myelopathy (HAM/TSP). Muscle Nerve 1993, 16: 21-26.
5. Gessain A, Vernant JC, Maurs L, Barin F, Gout O, Calender A, De Thé G. Antibodies to human T-lymphotropic virus type-1 in patients with tropical spastic paraparesis. Lancet 1985, 2: 407-410.
6. Janssen RS, Kaplan JE, Khabbaz RF et al. - HTLV-I associated myelopathy/tropical spastic paraparesis in the United States. Neurology 1991,41: 1355-1357.
7. Kajiyama W, Kashiwagi S, Ikematsu H, Hayashi J, Nomura H, Okochi K. Intrafamilial transmission of adult T-cell leukemia virus. J Infect Dis 1986, 154: 851-857.
8. Kira J, Minato S, Itoyama Y, Goto I, Kato M, Hasuo K. Leukoencephalopathy in HTLV-I associated myelopathy: MRI and EEG data. J Neurol Sci 1988, 87: 221-232.
9. Kuroda Y, Fukuoka M, Endo C, Matsui M, Kurohara K, Kakigi R, Tokunaga O. Occurrence of biliary cirrhosis, CREST syndrome and Sjogren's syndrome in a patient with HTLV-I associated myelopathy. J Neurol Sci 1993, 116: 47-51.
10. Lessa I, Moraes D, Meireles A, Melo A. HTLV-I and myelopathy in Salvador (Northeastern Brazil): a case control study. Arq Neuropsiquiatr 1993, 51: 447-451.
11. Mattos K, Queiroz C, Peçanha-Martins AC, Publio L, Melo A. Lymphocyte alveolitis in HAM/TSP patients. Arq Neuropsiquiatr 1993, 51: 134-136.
12. Mattos K. Estudo do lavado broco-alveolar em portadores de mielopatia associada a HTLV-I. Tese de Mestrado, Universidade Federal da Bahia, Salvador, 1993.
13. Meireles A, Moreira ED Jr, Moreno-Carvalho OA, Badaró R, Melo A. HTLV-I associated myelopathy in Salvador (Northeastern-Brazil). Arq Neuropsiquiatr 1992, 50: 189-190.
14. Melo A, Moura L, Rios S, Machado M, Costa G. Magnetic resonance imaging in HTLV-I associated myelopathy. Arq Neuropsiquiatr 1993, 51: 329-332.
15. Moreira ED Jr, Harrington W Jr, Ribeiro TT, Melo A, Brites C, Badaró R, Swanson P, Lee H. HTLV-II and a new endemic area for HTLV-I in Brazil. Rev Soc Bras Med Trop 1992, 25: 141-143.
16. Moreira ED Jr, Ribeiro TT, Swanson P, Sampaio C, Melo A, Brites C, Badaró R, Toedter G, Lee H, Harrington W Jr. Seroepidemiology of human T-cell lymphotropic virus type I/II in Northeastern Brazil. J AIDS 1993, p 959-963.
17. Moreno-Carvalho OA, Santos JI, Di Gredici G, Galvão B. Evidence of preferencial females prevalence of HTLV-I associated tropical spastic paraparesis in Bahia, Brazil. Arq Neuropsiquiatr 1992, 50: 183-188.
18. Osame M, Janssen RS, Kubota H, Nishitani H, Igata A. Nationwide survey of HTLV-I associated myelopathy in Japan: association with blood transfusion. Ann Neurol 1990, 28: 50-56.
19. Peregrino AJP, Oliveira SP, Porto CA, Santos LA, Menezes EE, Silva AP, Brito Al, Pinheiro SP, Pinheiro S, Dias AB. Meningomieloradiculite por Schistosoma mansoni. Arq Neuropsiquiatr 1988, 46: 49-60.
20. Public Health Service Working Group (FDA/CDC/NIH). Licensure of screening tests for antibody human T lymphotropic virus type I. Morbid Mortal Weekly Republic 1988, 37: 736-747.
21. Roman GC, Spencer PS, Schoenberg BS, Madden DL, Sever JL, Hugon J, Ludolph A, Spencer PS. Tropical spastic paraparesis in the Seychelles islands. Neurology 1987, 37: 1323-1328.
22. Roman GC. The neuroepidemiology of tropical spastic paraparesis. Ann Neurol 1988, 23 (Suppl) 113-130.
23. Roman GC. Tropical spastic paraparesis and HTLV-I myelitis. In Vinken PJ, Bruyn GW, Klawans HL (eds). Handbook of Clinical Neurology, Volume 56. Amsterdam: Elsevier, 1989, p 525-542.
24. Said G, Goulon-Groean C, Lacroix C, Fève A, Descamps H, Fouchard M. Inflammatory lesions of peripheral nerve in a patient with human T-lymphotropic virus type 1 associated myelopathy. Ann Neurol 1988, 24: 275-277.
25. Sheremata WA, Quencer R, Gatti E et al. Magnetic resonance imaging of tropical spastic paraparesis. Neurology 1987, 37 (Supp 1): 322.
26. Spina-França A, Livramento JA, Machado LR, Gomes HR, Vianna LS, Castro LHM, Nobrega JPS, Bacheschi LA. HTLV-I antibodies in serum and cerebrospinal fluid in tropical spastic paraparesis in Brazil. Arq Neuropsiquiatr 1990, 48: 441-447.
27. Swieten JC, Geyskes GG, Derix MMA. Hypertension in the elderly is associated with white matter lesions and cognitive decline. Ann Neurol 1991, 30: 825-830.
28. Zaninovic V, Arango C, Biojo R, Mora C, Rodgers-Johnson P, Concha M, Corrai R, Barreio P, Borriro I, Garruto RM, Gibbs CJ Jr, Gajdusek DC. Tropical spastic paraparesis in Colombia. Ann Neurol 1988, 23 (Suppl): S127-132.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Set 1994

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

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

[2] 2. Araújo AQC, Alfonso CR, Schor D, Leite AC, Andrade-Serpa MJ. Clinical and demographic features of HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Rio de Janeiro, Brazil. Acta Neurol Scand 1993, 88: 59-62.

[3] 3. Araújo AQC, Alfonso CR, Schor D, Andrade-Serpa MJ. Spastic paraparesis of obscure origin: a case control study of HTLV-I positive and negative patients from Rio de Janeiro, Brazil. J Neurol Sci 1993, 116: 165-169.

[4] 4. Bhigjee Al, Bill PLA, Wiley CA, Windsor IM, Mathias DA, Amenomori T,Wachsman W, Moorhouse D. Peripheral nerve lesions in HTLV-I associated myelopathy (HAM/TSP). Muscle Nerve 1993, 16: 21-26.

[5] 5. Gessain A, Vernant JC, Maurs L, Barin F, Gout O, Calender A, De Thé G. Antibodies to human T-lymphotropic virus type-1 in patients with tropical spastic paraparesis. Lancet 1985, 2: 407-410.

[6] 6. Janssen RS, Kaplan JE, Khabbaz RF et al. - HTLV-I associated myelopathy/tropical spastic paraparesis in the United States. Neurology 1991,41: 1355-1357.

[7] 7. Kajiyama W, Kashiwagi S, Ikematsu H, Hayashi J, Nomura H, Okochi K. Intrafamilial transmission of adult T-cell leukemia virus. J Infect Dis 1986, 154: 851-857.

[8] 8. Kira J, Minato S, Itoyama Y, Goto I, Kato M, Hasuo K. Leukoencephalopathy in HTLV-I associated myelopathy: MRI and EEG data. J Neurol Sci 1988, 87: 221-232.

[9] 9. Kuroda Y, Fukuoka M, Endo C, Matsui M, Kurohara K, Kakigi R, Tokunaga O. Occurrence of biliary cirrhosis, CREST syndrome and Sjogren's syndrome in a patient with HTLV-I associated myelopathy. J Neurol Sci 1993, 116: 47-51.

[10] 10. Lessa I, Moraes D, Meireles A, Melo A. HTLV-I and myelopathy in Salvador (Northeastern Brazil): a case control study. Arq Neuropsiquiatr 1993, 51: 447-451.

[11] 11. Mattos K, Queiroz C, Peçanha-Martins AC, Publio L, Melo A. Lymphocyte alveolitis in HAM/TSP patients. Arq Neuropsiquiatr 1993, 51: 134-136.

[12] 12. Mattos K. Estudo do lavado broco-alveolar em portadores de mielopatia associada a HTLV-I. Tese de Mestrado, Universidade Federal da Bahia, Salvador, 1993.

[13] 13. Meireles A, Moreira ED Jr, Moreno-Carvalho OA, Badaró R, Melo A. HTLV-I associated myelopathy in Salvador (Northeastern-Brazil). Arq Neuropsiquiatr 1992, 50: 189-190.

[14] 14. Melo A, Moura L, Rios S, Machado M, Costa G. Magnetic resonance imaging in HTLV-I associated myelopathy. Arq Neuropsiquiatr 1993, 51: 329-332.

[15] 15. Moreira ED Jr, Harrington W Jr, Ribeiro TT, Melo A, Brites C, Badaró R, Swanson P, Lee H. HTLV-II and a new endemic area for HTLV-I in Brazil. Rev Soc Bras Med Trop 1992, 25: 141-143.

[16] 16. Moreira ED Jr, Ribeiro TT, Swanson P, Sampaio C, Melo A, Brites C, Badaró R, Toedter G, Lee H, Harrington W Jr. Seroepidemiology of human T-cell lymphotropic virus type I/II in Northeastern Brazil. J AIDS 1993, p 959-963.

[17] 17. Moreno-Carvalho OA, Santos JI, Di Gredici G, Galvão B. Evidence of preferencial females prevalence of HTLV-I associated tropical spastic paraparesis in Bahia, Brazil. Arq Neuropsiquiatr 1992, 50: 183-188.

[18] 18. Osame M, Janssen RS, Kubota H, Nishitani H, Igata A. Nationwide survey of HTLV-I associated myelopathy in Japan: association with blood transfusion. Ann Neurol 1990, 28: 50-56.

[19] 19. Peregrino AJP, Oliveira SP, Porto CA, Santos LA, Menezes EE, Silva AP, Brito Al, Pinheiro SP, Pinheiro S, Dias AB. Meningomieloradiculite por Schistosoma mansoni. Arq Neuropsiquiatr 1988, 46: 49-60.

[20] 20. Public Health Service Working Group (FDA/CDC/NIH). Licensure of screening tests for antibody human T lymphotropic virus type I. Morbid Mortal Weekly Republic 1988, 37: 736-747.

[21] 21. Roman GC, Spencer PS, Schoenberg BS, Madden DL, Sever JL, Hugon J, Ludolph A, Spencer PS. Tropical spastic paraparesis in the Seychelles islands. Neurology 1987, 37: 1323-1328.

[22] 22. Roman GC. The neuroepidemiology of tropical spastic paraparesis. Ann Neurol 1988, 23 (Suppl) 113-130.

[23] 23. Roman GC. Tropical spastic paraparesis and HTLV-I myelitis. In Vinken PJ, Bruyn GW, Klawans HL (eds). Handbook of Clinical Neurology, Volume 56. Amsterdam: Elsevier, 1989, p 525-542.

[24] 24. Said G, Goulon-Groean C, Lacroix C, Fève A, Descamps H, Fouchard M. Inflammatory lesions of peripheral nerve in a patient with human T-lymphotropic virus type 1 associated myelopathy. Ann Neurol 1988, 24: 275-277.

[25] 25. Sheremata WA, Quencer R, Gatti E et al. Magnetic resonance imaging of tropical spastic paraparesis. Neurology 1987, 37 (Supp 1): 322.

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

[27] 27. Swieten JC, Geyskes GG, Derix MMA. Hypertension in the elderly is associated with white matter lesions and cognitive decline. Ann Neurol 1991, 30: 825-830.

[28] 28. Zaninovic V, Arango C, Biojo R, Mora C, Rodgers-Johnson P, Concha M, Corrai R, Barreio P, Borriro I, Garruto RM, Gibbs CJ Jr, Gajdusek DC. Tropical spastic paraparesis in Colombia. Ann Neurol 1988, 23 (Suppl): S127-132.