RESUMO
Human T-cell lymphotropic virus type I (HTLV-I), is the cause of endemic tropical spastic paraparesis (TSP) or HTLV-I-associated myelopathy (HAM). Because TSP/HAM is not a fatal disease, the neuropathology of this disease, albeit relatively well understood, is based on the examination of just a few incidental cases. Previously, we demonstrated peculiar lamellated structures, called "multilamellar bodies" (MLB). In this report, we present the ultrastructural neuropathology of a TSP/HAM case from Chile, with further detailed descriptions of MLB. It is tempting to suggest that MLB may represent specific ultrastructural markers of TSP/HAM. The pathology of the anterior and posterior horns was similar and was comprised of axonal degeneration, accompanied by extensive astrocytic gliosis. Lymphocytic infiltration, particularly observed as "cuffs" around blood vessels, was scattered among other cellular elements. Ultrastructurally, myelin sheaths were relatively well preserved, and some demyelinated but not remyelinated fibers were observed. Moreover, axons with abnormal accumulations of neurofilaments, suggestive of axonal degeneration, were detected. Several axons contained Hirano bodies. In many samples, glial processes replaced most of the remaining neuropil. In a few specimens of the anterior and posterior horns of the spinal cord, MLB were observed. These structures consisted of stacks of 30 to 40 electron-dense lamellae, which were interrupted by narrow electron-lucent spaces. All of the lamellae were immersed within an amorphous substance of intermediate density. Neurons of the dorsal root ganglia were basically normal except for increased lipofuscin accumulation. As in the spinal cord, myelinated axons were well preserved, but a few were demyelinated and surrounded by concentric arrays of Schwann cell membranes. Also, axons of the dorsal roots accumulated increased number of neurofilaments. Mast cells and Schwann cells were increased in number, the latter containing abundant pi granules and myelin fragments.
Assuntos
Lobo Frontal/ultraestrutura , Gânglios Espinais/ultraestrutura , Músculo Esquelético/ultraestrutura , Paraparesia Espástica Tropical/patologia , Medula Espinal/ultraestrutura , Astrócitos/ultraestrutura , Axônios/ultraestrutura , Chile , Glicogênio/metabolismo , Humanos , Lipofuscina/metabolismo , Linfócitos/patologia , Bainha de Mielina/ultraestrutura , Miofibrilas/ultraestrutura , Neurofibrilas/ultraestrutura , Vacúolos/ultraestruturaRESUMO
Descriptive epidemiological data are presented from a survey of 35 cases of Creutzfeldt-Jakob disease (CJD) that occurred in Chile in the period 1955 to 1977. The average mortality in Chile (0.31 deaths per 1 million) and in urban Santiago (0.73 deaths per 1 million) is compared with data reported from other countries. An increasing incidence in recent years is probably related to a greater awareness of the disease. The familial occurrence of CJD in nine patients from five affected families is described, and its analysis suggests a genetically determined susceptibility with incubation periods of more than 30 years. Horizontal transmission of the disease may have occurred in one patient in whom the disease developed 13 years after the patient married into a family with seven other affected members.