HTLV-1 and neurological conditions: when to suspect and when to order a diagnostic test for HTLV-1 infection?

Abstract

-HTLV-1 is a retrovirus associated with a myriad of clinical conditions, especially hematological and neurological ones. Regarding nervous system diseases, it is of utmost importance to select those cases in which HTLV-1 infection could really be associated. This is particularly true for patients from endemic areas and for HIV-infected patients and drug users, since that these groups are at a higher risk for HTLV infection. This caution in selecting neurological patients for HTLV diagnostic tests is justified by the fact that in some circumstances the seropositivity may merely represent an epiphenomenon. In this paper we enroll some neurological conditions that have been associated with HTLV-1/2 infection in the literature and discuss the real need for HTLV-1/2 diagnostic tests in each one. Because HIV/HTLV-co-infected patients seem to be at an increased risk for neurological diseases development, a special consideration about this matter is also made.KEy WORDs: HTLV, myelopathy, myopathy, peripheral neuropathy, HIV.doenças neurológicas e infecção pelo HTLV-1: quando suspeitar e quando solicitar testes diagnósticos para a infecção pelo HTLV-1Resumo -O HTLV-1 é um retrovírus associado tanto a doenças hematológicas quanto a doenças neurológicas. Em relação às doenças neurológicas, é fundamental que selecionemos aquelas em que de fato a infecção pelo HTLV-1 possa ser a causa. Isto é particularmente verdadeiro nos pacientes oriundos de áreas endêmicas e nos pacientes infectados pelo HIV e usuários de drogas, haja vista que estes grupos são de risco para infecção pelo HTLV. Este cuidado ao selecionarmos aquelas condições neurológicas que merecem ser investigadas com sorologia para o HTLV se justifica pelo fato de que nem sempre podemos afastar uma associação fortuita entre a infecção e a referida doença. Neste artigo, comentaremos sobre algumas condições neurológicas que podem estar associadas com a infecção pelo HTLV-1/2, discutindo a real necessidade de solicitar testes para o diagnóstico da infecção pelo HTLV-1/2 frente a elas. Uma breve consideração sobre a co-infecção HIV/ HTLV será feita no final deste artigo tendo em vista que estes pacientes apresentam um risco aumentado para o desenvolvimento de doenças neurológicas.PALAVRAs-CHAVE: HTLV, mielopatia, miopatia, neuropatia periférica, HIV.The human T cell lymphotropic virus type 1 (HTLV-1) is a retrovirus and the etiologic agent of both a group of hematological disorders known as Adult T cell leukemia/ lymphoma (ATLL) 1 and a group of neurological conditions known altogether as the HTLV-1 neurological complex 2 , of which the most common is the HTLV-1 associated myelopathy/Tropical spastic paraparesis (HAM/TsP) 3 . Endemic infection with HTLV-1 is now recognized to be worldwide, and is also common in Brazil 4 . The number of people around the world infected with HTLV-1 is estimated as being between 10 to 20 million. There are areas in Japan, sub-saharan Africa, the Caribbean, and south America where more than 1% of the general population is infected. T...

Neurological symptoms and signs in HTLV-1 patients with overactive bladder syndrome

“…Taken together, our data and those of others suggest that HTLV-I infection is associated with a wide spectrum of neurological dysfunction and that HAM/TSP is only the “tip of the iceberg” 5 . In particular, patients with symptoms of overactive bladder tend to have more neurologic complaints and should be monitored carefully for progression of neurologic disease.…”

Spontaneous Bladder Rupture in a Patient With Human T-cell Lymphotropic Virus Type 1: A Case Report

“…The pathogenesis of neurological manifestationsin a HTLV1 infection arepoorly understood. Up to 90% of HAM/TSP patients have urologic manifestations, such as: urgency, nocturia, urge incontinence, dysuria, and straining (11,12). In the aforementioned group, the major abnormality is over-active bladder syndrome, and detrusor over-activity, followed by detrusor external sphincter dyssynergia (13).…”

Motor behavioral abnormalities and histopathological findings of Wistar rats inoculated with HTLV-1-infected MT2 cells

“…In addition, Pro-viral gene detection by PCR may be possible only after prolonged infection (more than 20 months after inoculation) (7). Two (8%) rats developed hind limb paralysis, a rate somewhat higher than the human prevalence of HTLV-1-associated myelopathy, which is only 0.25 to 5% of the infected population (8,9). In human patients, the motor symptoms are broad and partial, impairing full gait, but not abolishing it completely, and only during the terminal phase, restricting the patients to wheelchairs or beds (10,11).…”