RESUMO
From an index case of tropical spastic paraparesis (TSP), four generations of a Brazilian family of African descent were investigated for human T-lymphotropic virus type I (HTLV-I) infection and its association with neurologic manifestations, as well as the possible routes of transmission. Thirty-two individuals were studied. Polymerase chain reaction (PCR) was used for confirmation of infection. HTLV-I infection was demonstrated in eight subjects (the index case, 6 of 24 blood relatives, and 1 of 7 spouses). The index case and two blood relatives had TSP, whereas subclinical neurologic disturbances were present in three other blood relatives and one spouse. Another member of the family, who had died before this study, had had diagnoses of spastic paraparesis of unknown etiology and small-cell lymphoma. Only 1 of 8 infected individuals was neurologically intact. Of 5 vertically infected individuals, 4 had been breast-fed for long periods (1-2 years). These are the first reported cases of PCR-proved HTLV-I-associated spastic paraparesis in Brazil.
Assuntos
Infecções por HTLV-I/transmissão , Paraparesia Espástica Tropical/transmissão , Adulto , Idoso , Idoso de 80 Anos ou mais , Western Blotting , Brasil , Aleitamento Materno , Criança , Pré-Escolar , Feminino , Anticorpos Anti-HTLV-I/sangue , Anticorpos Anti-HTLV-I/líquido cefalorraquidiano , Infecções por HTLV-I/diagnóstico , Anticorpos Anti-HTLV-II/sangue , Anticorpos Anti-HTLV-II/líquido cefalorraquidiano , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/diagnóstico , Linhagem , Reação em Cadeia da Polimerase , Reflexo Anormal , Fatores de RiscoRESUMO
We studied the clinical records of 280 patients admitted to our Hospital between 1985 and 1988, with a positive Elisa test for HIV-related antibodies: 15.71% (44) of these patients exhibited clinical abnormalities related to disease of the CNS. In 6 (13.6%) patients the neurological complication was the first manifestation of HIV-infection. Patients were mainly male homosexuals, in the 30-39 age range. Frequent chief complaints included hemiparesis, headache and behavior disturbances. Cerebral toxoplasmosis was diagnosed in 18 instances. It should be considered the first diagnostic possibility in patients presenting with mass lesions. Meningeal infections were present in 19 cases (cryptococcal in 13, tuberculous in 4, HIV-related in 2). CSF findings in these patients were non specific, except for demonstration of Cryptococcus neoformans on direct examination of CSF or culture studies. CT scans frequently displayed unique or multiple hypodense lesions. The lesions exhibited ring-enhancement in 7 instances, and were non-enhancing in 8 others. Cortical and subcortical atrophy with hydrocephalus ex-vacuum were occasionally found, and the CT scans were normal in 8 instances. Time from appearance of the various neurological complications to death or clinical resolution was almost always shorter than 6 months. Death was the most frequent outcome, usually occurring within 6 months. Survival in the most of these patients never reached the end of the first year.