RESUMO
OBJECTIVES: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotrophic virus type I (HTLV-I). DESIGN: A case series of patients with ID were compared with patients with atopic dermatitis (AD), which is an important disease in the differential diagnosis of ID. SETTING: Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica. MAIN OUTCOME MEASURES: Clinical and laboratory features of patients with AD were compared with those of patients with ID. PATIENTS: Consecutive patients older than 1 1/2 years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings. RESULTS: The mean ages of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both diseases were predominantly chronic dermatitis with propensity for skin colonization with Staphylococcus aureus and beta-hemolytic streptococci; however, the distribution of sites of skin involvement differed. Infection with HTLV-I was the most distinguishing feature among patients with ID, with seropositive results in 100%; only 5 (14%) of the 35 patients with AD had results seropositive for HTLV-I. Infective dermatitis was further characterized by dermatopathic lymphadenitis in 16 (67%) of 24 patients with palpable nodes. Anemia, lymphocytosis, and low albumin and elevated serum globulin levels were more prevalent among patients with ID. Significant elevations of IgA, IgD, and IgG levels were observed among patients with ID compared with those with AD. However, both patients with AD and those with ID had levels of IgD and IgE elevated above the normal range. T-cell subsets among patients with ID revealed T-cell activation with a high percentage of HLA-DR antigen positivity, elevated CD4 (2.4 x 10(9)/L) and CD8 (1.4 x 10(9)/L) cell counts, with an increased CD4/CD8 ratio of 1:73. CONCLUSION: Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.
Assuntos
Dermatite/patologia , Dermatite/virologia , Infecções por HTLV-I/imunologia , Infecções por HTLV-I/patologia , Adolescente , Adulto , Linfócitos T CD4-Positivos/patologia , Linfócitos T CD8-Positivos/patologia , Contagem de Células , Criança , Pré-Escolar , Dermatite/imunologia , Dermatite Atópica/imunologia , Dermatite Atópica/microbiologia , Dermatite Atópica/patologia , Feminino , Infecções por HTLV-I/fisiopatologia , Humanos , Lactente , Ativação Linfocitária/fisiologia , Masculino , Pele/patologia , Staphylococcus aureus/isolamento & purificação , Streptococcus agalactiae/isolamento & purificaçãoAssuntos
Infecções por HTLV-I , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Dermatopatias Infecciosas , Biomarcadores/análise , Criança , Pré-Escolar , Dermatite/diagnóstico , Dermatite/fisiopatologia , Dermatite/terapia , Diagnóstico Diferencial , Infecções por HTLV-I/diagnóstico , Infecções por HTLV-I/fisiopatologia , Infecções por HTLV-I/terapia , Humanos , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/fisiopatologia , Dermatopatias Infecciosas/terapia , Clima TropicalRESUMO
Infective dermatitis (ID) of Jamaican children, a distinctive pattern of dermatitis first described in Jamaican children in 1966 was found to be associated with human T-cell lymphotropic virus type I (HTLV-I) infection in 1990. Since then, ID has been reported from other HTLV-I endemic areas. Further studies have confirmed the HTLV-I association and have demonstrated immunologic abnormalities in cellular and humoral immune systems as well as at the subcellular level. Viral genome has been detected in cultured skin biopsy material, and genetic factors may predispose people to the development of ID. Transmission of HTLV-I infection in ID appears to be from mother to infant via breast milk. Present therapy is with long-term antibiotics to control bacterial infection and hence the dermatitis. Complications are frequent and include crusted scabies, corneal opacities, chronic bronchiectasis, parasitic worm infestation, early death, and progression to more severe HTLV-I-associated disorders such as adult T-cell leukemia/lymphoma and HTLV-I-associated myelopathy/tropical spastic paraparesis. Future studies are planned to determine the precise immunologic defect, the role of socioeconomic and nutritional factors, and the natural history. Intervention studies to limit breast feeding and hence HTLV-I transmission are also planned.
Assuntos
Dermatite/virologia , Infecções por HTLV-I/história , Adolescente , Adulto , Formação de Anticorpos , Criança , Pré-Escolar , Feminino , Genoma Viral , Infecções por HTLV-I/transmissão , História do Século XX , Humanos , Imunidade Celular , Lactente , Jamaica , Masculino , Pele/virologiaRESUMO
Since human T-cell lymphotropic virus (HTLV-I) was identified in 1980 as causing human disease, it has been etiologically associated with adult T-cell lymphoma/leukemia (ATL) and tropical spastic paraparesis (TSP). More recently, several new diseases have been reported in association with this virus, including infective dermatitis of Jamaican children, which we reported in 1990. Studies on infective dermatitis have shown that these children have abnormalities of immune function, and some develop other HTLV-I associated disorders, including TSP. This paper reviews the work done on infective dermatitis to date, and explores the association with TSP.
Assuntos
Dermatite/virologia , Infecções por HTLV-I/virologia , Vírus Linfotrópico T Tipo 1 Humano/patogenicidade , Paraparesia Espástica Tropical/virologia , Adulto , Criança , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Jamaica , Pessoa de Meia-IdadeRESUMO
A randomized controlled trial of Solcoseryl, DuoDerm and conventional conservative therapy with Eusol has been performed in 32 patients with homozygous sickle-cell (SS) disease. After 12 weeks' baseline observation, patients were randomized to one of three therapies and monitored for a further 12 weeks. Of 44 ulcerated legs, 20 received control treatment, 12 Solcoseryl and 12 DuoDerm. DuoDerm was generally unacceptable, and two-thirds of the patients defaulted from this treatment. Solcoseryl increased ulcer healing compared to the controls but the difference was not significant. Solcoseryl was well tolerated and may have a role in the treatment of chronic leg ulcers of sickle-cell disease.