Chronic Myelopathy Associated with Human T-Lymphotropic Virus Type I (HTLV-I)
- 1 December 1992
- journal article
- review article
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 117 (11), 933-946
- https://doi.org/10.7326/0003-4819-117-11-933
Abstract
▪ Purpose: To review the clinical, epidemiologic, immunologic, and virologic aspects of the chronic myelopathy associated with human T-cell leukemia/lymphoma virus type I (HTLV-I), currently called tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). ▪ Data Identification: Studies done after 1985, when TSP/HAM was first recognized, were identified by a computer search using MEDLARS II and CANCERLIT. Additional information was acquired from personal files and bibliographies of existing literature. ▪ Study Selection: A total of 400 articles, 90 book chapters, and 150 abstracts from meetings covering all aspects of HTLV-I and neurologic diseases were critically analyzed, and information from 250 publications was included. ▪ Results of Data Analysis: TSP/HAM is present in most HTLV-I endemic areas, with a prevalence ranging from 5.1 to 128 per 100 000 inhabitants. Up to 20% of patients develop TSP/HAM after transfusion of HTLV-I contaminated blood. Pathologic characteristics indicate a chronic meningomyelitis. The clinical features consist of a chronic progressive spastic paraparesis or paraplegia, sphincter disturbances, and minimal sensory loss. Supraspinal and peripheral nerve involvement is sometimes observed. High titers of HTLV-I-specific antibodies are present in the serum and cerebrospinal fluid. The high level of humoral and cellular immunologic response and the association of TSP/HAM with other immunologic diseases suggest an immune-mediated process. Corticosteroids and immunosuppressor treatment usually result in only short-term improvement. ▪ Conclusion: TSP/HAM is a common neurologic disease in many parts of the world. All patients with chronic progressive myelopathies should be tested for serum and cerebrospinal fluid HTLV-I-specific antibodies. Systematic screening of blood donors for HTLV-I is necessary to help prevent the dissemination of the virus and the occurrence of post-transfusional cases.Keywords
This publication has 100 references indexed in Scilit:
- HTLV-I—associated myelopathy in a patient with adult T-cell leukemiaJournal of the American Academy of Dermatology, 1991
- Sequence variations in ltr and env regions of HTLV‐I do not discriminate between the virus from patients with HTLV‐I‐associated myelopathy and adult T‐cell leukemiaInternational Journal of Cancer, 1991
- Nationwide survey of HTLV‐I–associated myelopathy in Japan: Association with blood transfusionAnnals of Neurology, 1990
- Demyelination and remyelination in spinal cord lesions of human lymphotropic virus type I-associated myelopathyActa Neuropathologica, 1990
- Increased replication of HTLV‐I in HTLV‐I–associated myelopathyAnnals of Neurology, 1989
- Activated t‐lymphocytes with polyclonal gammopathy in patients with human t‐lymphotropic virus type i—associated myelopathyAnnals of Neurology, 1988
- HTLV-I ASSOCIATED MYELOPATHY, A NEW CLINICAL ENTITYThe Lancet, 1986
- Multiple sclerosis and human T-cell lymphotropic retrovirusesNature, 1985
- ANTIBODIES TO HUMAN T-LYMPHOTROPIC VIRUS TYPE-I IN PATIENTS WITH TROPICAL SPASTIC PARAPARESISThe Lancet, 1985
- New diagnostic criteria for multiple sclerosis: Guidelines for research protocolsAnnals of Neurology, 1983