RESUMO
Cerebellar symptoms at onset are unusual in HTLV-I/II-associated tropical spastic paraparesis (TSP). A prospective study of neurological disorders in Panama (1985-1990) revealed 13 patients with TSP and 3 with HTLV-I/II-associated spinocerebellar syndrome (HSCS) presenting at onset loss of balance, wide-based stance and gait, truncal instability, and mild leg ataxia (vermian cerebellar syndrome), with absent upper limb dysmetria but with postural tremor, downbeat nystagmus, and dysarthria. In 4-5 years, spinal cord manifestations of TSP developed, including spastic paraparesis, pyramidal signs, bladder and sphincter disturbances. Two patients were infected with HTLV-I and another one, a Guaymi Amerindian woman, with HTLV-II. Magnetic resonance imaging (MRI) demonstrated cerebellar atrophy involving predominantly the superior vermis. Mild axonal peripheral neuropathy in the lower limbs, dorsal column involvement and inflammatory myopathy were found by neurophysiology studies. There are 14 similar cases reported in Japan and Canada, but to our knowledge these are the first documented cases of HSCS in the tropics. A cerebellar syndrome constitutes another form of presentation of HTLV-I/II infection of the nervous system.
Assuntos
Cerebelo/patologia , Cerebelo/virologia , Infecções por Deltaretrovirus/complicações , Infecções por Deltaretrovirus/patologia , Vírus Linfotrópico T Tipo 1 Humano/fisiologia , Vírus Linfotrópico T Tipo 2 Humano/fisiologia , Degenerações Espinocerebelares/patologia , Degenerações Espinocerebelares/virologia , Cerebelo/fisiopatologia , Infecções por Deltaretrovirus/virologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Panamá , Degenerações Espinocerebelares/fisiopatologiaRESUMO
Three of 6 patients with spastic paraparesis in Lima, Peru, were found to have antibodies to human T-lymphotropic virus type I (HTLV-I). Blood and cerebrospinal fluid antibodies were confirmed by Western blot analysis. Multilobulated lymphocytes in blood and cerebrospinal fluid of the index case stained with monoclonal antibodies for T-helper cells and for T10, an activation marker. Blood mononuclear cells from patients with HTLV-I-associated myelopathy showed spontaneous proliferation in culture, evidence of interleukin-2 receptors, and decreased natural killer cell activity.
Assuntos
Infecções por Deltaretrovirus , Paraplegia/etiologia , Adulto , Idoso , Anticorpos Antivirais/análise , Anticorpos Antivirais/líquido cefalorraquidiano , Células Sanguíneas/patologia , Divisão Celular , Anticorpos Antideltaretrovirus , Infecções por Deltaretrovirus/líquido cefalorraquidiano , Infecções por Deltaretrovirus/imunologia , Infecções por Deltaretrovirus/patologia , Feminino , Humanos , Leucócitos Mononucleares/patologia , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/líquido cefalorraquidiano , Espasticidade Muscular/etiologia , Espasticidade Muscular/imunologia , Espasticidade Muscular/patologia , Mielite/etiologia , Paraplegia/líquido cefalorraquidiano , Paraplegia/imunologia , Paraplegia/patologia , Peru , Linfócitos T/classificaçãoRESUMO
Of 95 patients consecutively diagnosed with non-Hodgkin lymphoma, 52 (55%) had antibodies to human T-cell leukemia-lymphoma virus, type I. Antibody positivity was strongly associated with skin involvement, leukemia, and hypercalcemia (p less than 0.02). Two patients had systemic opportunistic infections. Neither meningeal nor lung infiltration was detected, and lymph node infiltration was diffuse in all patients. Of 36 patients who received immunophenotypic classifications, 30 had diseases that affected the T-cell system, and the cells of all tested patients with these diseases showed the helper/inducer (T4) phenotype. Twenty-seven of these thirty-six patients were found to have adult T-cell leukemia-lymphoma, and of the 27, 24 had antibodies to HTLV-I. The median duration of survival in patients with adult T-cell leukemia-lymphoma was 17 weeks, but a subgroup of 9 patients had indolent courses and a median survival of 81 weeks, which suggests that the disease has differing expression with courses that range from smoldering and indolent to acute and rapidly fatal. Hypercalcemia was the most important prognostic determinant of adult T-cell leukemia-lymphoma.
Assuntos
Infecções por Deltaretrovirus/epidemiologia , Linfoma não Hodgkin/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Infecções por Deltaretrovirus/mortalidade , Infecções por Deltaretrovirus/patologia , Feminino , Humanos , Hipercalcemia/mortalidade , Infecções/mortalidade , Jamaica , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos ProspectivosRESUMO
Of 95 patients consecutively diagnosed with non-hodgkin lymphoma, 52(55 percent) had antibodies to human T-cell leukemia-lymphoma virus, type I. Antibody positively was strongly associated with skin involvement, leukemia, and hypercalcemia (p<0.02). Two patients had systemic opportunistic infections. Neither meningeal nor lung infiltration was detected, and lymph node infiltration was diffuse in all patients. Of 36 patients who received immunophenotypic classifications, 30 had diseases that affected the T-cell system, and the cells of all tested patients with these diseases showed the helper/inducer (T4) phenotype. Twenty-seven of these thirty-six patients were found to have adult T-cell leukemia-lymphoma, and of the 27, 24 had antibodies to HTLV-I. The median duration of survival in patients with adult T-cell leukemia-lymphoma was 17 weeks, but a subgroup of 81 weeks, which suggests that the disease has differing expression with courses that range from smoldering and indolent to acute and rapidly fatal. Hypercalcemia was the most important prognostic determinnant of adult T-cell leukemia-lymphoma.(AU)