RESUMO
We report clinical and laboratory investigations of 47 native-born Jamaican patients with endemic tropical spastic paraparesis and of 1 patient with tropical ataxic neuropathy. Mean age at onset was 40 years, with a female-male preponderance (2.7:1). Neurological features of endemic tropical spastic paraparesis are predominantly those of a spastic paraparesis with variable degrees of proprioceptive and/or superficial sensory impairment. Using enzyme-linked immunoabsorbent assay (ELISA), IgG antibodies to human T-lymphotropic virus type I (HTLV-I) were present in 82% of sera and 77% of cerebrospinal fluids. On Western blot analysis, IgG antibodies detected the p19 and p24 gag-encoded core proteins in both serum and cerebrospinal fluid. Titers were tenfold higher by ELISA in serum than in cerebrospinal fluid, and some oligoclonal bands present in fluid were not seen in serum. Serum-cerebrospinal fluid albumin ratios were normal, and IgG indexes indicated intrathecal IgG synthesis. Histopathological changes showed a chronic inflammatory reaction with mononuclear cell infiltration, perivascular cuffing, and demyelination that was predominant in the lateral columns. In 1 patient, a retrovirus morphologically similar to HTLV-I on electron microscopy was isolated from spinal fluid. Our investigations show that endemic tropical spastic paraparesis in Jamaica is a retrovirus-associated myelopathy and that HTLV-I or an antigenically similar retrovirus is the causal agent.
Assuntos
Infecções por Deltaretrovirus/complicações , Paraplegia/etiologia , Medicina Tropical , Adolescente , Adulto , Idoso , Anticorpos Anti-Idiotípicos/análise , Anticorpos Antivirais/análise , Deltaretrovirus/isolamento & purificação , Anticorpos Antideltaretrovirus , Feminino , Humanos , Imunoglobulina G/imunologia , Jamaica , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/líquido cefalorraquidiano , Espasticidade Muscular/etiologia , Espasticidade Muscular/imunologia , Paraplegia/líquido cefalorraquidiano , Paraplegia/imunologiaRESUMO
A high-incidence focus of tropical spastic paraparesis (TSP) occurs on the South Pacific coast of Colombia. Of 55 patients studied, 52 (94.5%) had IgG antibodies to the human T-cell lymphotropic virus type I (HTLV-I) in serum and/or cerebrospinal fluid. Control groups did not show similar high positivity. Our results suggest that HTLV-I or other antigenically related retroviruses may be the cause of TSP in Colombia. Similar clinical, laboratory, and epidemiological findings have been reported in widely remote geographical regions of the world, with very similar clinical pictures of TSP in all high-incidence regions. The demonstration of IgG antibodies in serum and cerebrospinal fluid of patients with TSP in the Caribbean and Seychelles Islands, southern Japan, and the Ivory Coast indicate that the HTLV-I retrovirus could be the cause of this "tropical" myeloneuropathy.
Assuntos
Anticorpos Antivirais/análise , Paraplegia/epidemiologia , Medicina Tropical , Adolescente , Adulto , Anticorpos Anti-Idiotípicos/análise , Anticorpos Anti-Idiotípicos/líquido cefalorraquidiano , Anticorpos Antivirais/síntese química , Colômbia , Anticorpos Antideltaretrovirus , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina G/imunologia , Imunoglobulinas/análise , Imunoglobulinas/líquido cefalorraquidiano , Focalização Isoelétrica , Masculino , Espasticidade Muscular/líquido cefalorraquidiano , Espasticidade Muscular/epidemiologia , Espasticidade Muscular/imunologia , Bandas Oligoclonais , Paraplegia/líquido cefalorraquidiano , Paraplegia/imunologiaRESUMO
The clinical syndrome earlier designated as paraparesia espástica del Pacífico is an isolated form of tropical spastic paraparesis (TSP) that was reported in 1981 in the southern Pacific lowlands of Columbia in and near Tumaco. The clinical features are similar to those of TSP reported in Jamaica, Martinique, the Seychelles, and the Ivory Coast of Africa and resemble also those clinical features of the human T-lymphotropic virus type I (HTLV-I)-associated myelopathy described in southern Japan. Since HTLV-I infection is closely associated with TSP, we conducted a case-control study to evaluate the role of HTLV-I-associated risk factors among patients from the endemic focus in Tumaco, Colombia, and the seroprevalence rates of this virus in other geographical areas of the Pacific Colombian lowlands with and without TSP. From our seroprevalence study of antibodies to HTLV-I among TSP index patients, matched controls, household contacts (first- and second-degree relatives), and healthy controls from these areas, we found a strong association between HTLV-I and TSP. Also, there is a high seroprevalence of HTLV-I among sexual partners of patients and to a lesser extent among their offspring and other relatives some of whom had an early mean acquisition of antibodies to HTLV-I. Heterosexual promiscuity and other close interpersonal contact may play an important role in the transmission of TSP in the Pacific lowlands of Colombia.
Assuntos
Infecções por Deltaretrovirus/epidemiologia , Paraplegia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/análise , Criança , Colômbia , Anticorpos Antideltaretrovirus , Infecções por Deltaretrovirus/complicações , Infecções por Deltaretrovirus/genética , Infecções por Deltaretrovirus/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/complicações , Espasticidade Muscular/epidemiologia , Espasticidade Muscular/genética , Espasticidade Muscular/imunologia , Paraplegia/complicações , Paraplegia/genética , Paraplegia/imunologia , Parceiros Sexuais , Clima TropicalRESUMO
Red blood cell count (RBC), hemoglobin concentration ([Hb]) and hematocrit (Hct) were measured in 303 male Quechua children and adults, aged 6 to 57 years, living a lifestyle as traditional pastoralists and horticulturalists at a mean altitude of 4,200 m in the Southern Peruvian Andes. Values for RBC, [Hb], and Hct increased with age from middle childhood to young adulthood. However, among adults there was no significant association between age and any of these three parameters. Overall, there was approximately a 10-12% increase in the RBC, [Hb], and Hct above sea-level norms for all age groups. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) showed a slight but significant increase with age in children and adolescents, but the mean corpuscular hemoglobin concentration (MCHC) did not. We conclude that the study of highland Quechua Indians, living a traditional lifestyle as pastoralists and horticulturalists, does not support the long-held belief that altitude hypoxia provokes a dramatic compensatory polycythemia in healthy Andeans.