Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis
Background: Vertical transmission of HTLV-1 could lead to the early development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). This significantly affects quality of life and increases morbimortality. Objective: To describe the epidemiological and clinical characteristics of...
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doaj-4ac6c1f9719d40398ee5c5bd2652d57a2020-11-25T02:24:27ZengMDPI AGPathogens2076-08172020-06-01945045010.3390/pathogens9060450Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic ParaparesisAlvaro Schwalb0Valeria Pérez-Muto1Rodrigo Cachay2Martín Tipismana3Carolina Álvarez4Fernando Mejía5Elsa González-Lagos6Eduardo Gotuzzo7Instituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, PeruSchool of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, PeruBackground: Vertical transmission of HTLV-1 could lead to the early development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). This significantly affects quality of life and increases morbimortality. Objective: To describe the epidemiological and clinical characteristics of patients with early-onset HAM/TSP, defined as disease onset before 20 years of age. Methods: This is a retrospective study from an HTLV-1 clinical cohort between 1989 and 2019. We searched for medical records of patients with (1) diagnosis of HTLV-1 infection using two ELISA and/or one Western blot, (2) clinical diagnosis of HAM/TSP by neurological assessment, and (3) HAM/TSP symptom-onset before 20 years of age. Results: A total of 38 cases were identified in the cohort; 25 were female (66%). The median age of onset was 14 years old. 31 (82%) cases had HTLV-1 testing done among family members; 22 out of 25 tested mothers (88%) were HTLV-1 positive. Most patients (27/34) were breastfed for more than one year. Disease progression measured through EDSS and IPEC-1 showed an upward trend towards worsening spasticity with 18 patients (47%) eventually requiring mobility aids. Conclusions: Cases of early-onset HAM/TSP are not of rare occurrence, which translates into many more years of dependency, the use of mobility aids, and increased overall morbidity.https://www.mdpi.com/2076-0817/9/6/450HAM/TSPmyelopathyparaparesischronic infectioninflammation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alvaro Schwalb Valeria Pérez-Muto Rodrigo Cachay Martín Tipismana Carolina Álvarez Fernando Mejía Elsa González-Lagos Eduardo Gotuzzo |
spellingShingle |
Alvaro Schwalb Valeria Pérez-Muto Rodrigo Cachay Martín Tipismana Carolina Álvarez Fernando Mejía Elsa González-Lagos Eduardo Gotuzzo Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis Pathogens HAM/TSP myelopathy paraparesis chronic infection inflammation |
author_facet |
Alvaro Schwalb Valeria Pérez-Muto Rodrigo Cachay Martín Tipismana Carolina Álvarez Fernando Mejía Elsa González-Lagos Eduardo Gotuzzo |
author_sort |
Alvaro Schwalb |
title |
Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis |
title_short |
Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis |
title_full |
Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis |
title_fullStr |
Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis |
title_full_unstemmed |
Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis |
title_sort |
early-onset htlv-1-associated myelopathy/tropical spastic paraparesis |
publisher |
MDPI AG |
series |
Pathogens |
issn |
2076-0817 |
publishDate |
2020-06-01 |
description |
Background: Vertical transmission of HTLV-1 could lead to the early development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). This significantly affects quality of life and increases morbimortality. Objective: To describe the epidemiological and clinical characteristics of patients with early-onset HAM/TSP, defined as disease onset before 20 years of age. Methods: This is a retrospective study from an HTLV-1 clinical cohort between 1989 and 2019. We searched for medical records of patients with (1) diagnosis of HTLV-1 infection using two ELISA and/or one Western blot, (2) clinical diagnosis of HAM/TSP by neurological assessment, and (3) HAM/TSP symptom-onset before 20 years of age. Results: A total of 38 cases were identified in the cohort; 25 were female (66%). The median age of onset was 14 years old. 31 (82%) cases had HTLV-1 testing done among family members; 22 out of 25 tested mothers (88%) were HTLV-1 positive. Most patients (27/34) were breastfed for more than one year. Disease progression measured through EDSS and IPEC-1 showed an upward trend towards worsening spasticity with 18 patients (47%) eventually requiring mobility aids. Conclusions: Cases of early-onset HAM/TSP are not of rare occurrence, which translates into many more years of dependency, the use of mobility aids, and increased overall morbidity. |
topic |
HAM/TSP myelopathy paraparesis chronic infection inflammation |
url |
https://www.mdpi.com/2076-0817/9/6/450 |
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