Marcusso Rosa Maria do Nascimento, Assone Tatiane, Haziot Michel E, Smid Jerusa, Folgosi Victor A, Rosadas Carolina, Casseb Jorge, de Oliveira Augusto C Penalva
Instituto de Infectologia Emílio Ribas, São Paulo 01246-000, Brazil.
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil.
Pathogens. 2024 May 13;13(5):403. doi: 10.3390/pathogens13050403.
Several studies suggest that HTLV-1 infection may be associated with a wider spectrum of neurological and clinical manifestations that do not meet diagnostic criteria for HAM. These conditions may later progress to HAM or constitute an intermediate clinical form: intermediate syndrome (IS), a mid-point between asymptomatic HTLV-1 carriers and those with full myelopathy. Thus, we determined the incidence of HAM cases in the HTLV-1-asymptomatic and IS patients, and the clinical/laboratory associated markers. A total of 204 HTLV-1-positive patients were included in this study, divided into two groups: Group 1, including 145 asymptomatic HTLV-1 subjects (ASY), and Group 2, including 59 patients with inflammatory clinical symptoms in more than three systems and a high proviral load (PVL). During a 60-month follow-up time, with the age ranging from 47 to 79 years, ten patients of the fifty-nine initially diagnosed as IS developed HAM (iHAM), and two patients of the initial 145 ASY developed HAM directly. Women were more prevalent in all groups. For the iHAM patients, the age ranged from 20 to 72 years, with a mean of 53 (±15 SD). Older age was associated with the development of HAM, higher PVL and IS; however, there was no any specific symptom or clinical sign, that was associated with risk for iHAM. In conclusion, IS cases could be an early phase of development of HAM. These findings show the presence of higher incidence probabilities in our cohort than previously reported.
多项研究表明，人类嗜T淋巴细胞病毒1型（HTLV-1）感染可能与一系列更广泛的神经和临床表现相关，这些表现不符合热带痉挛性截瘫（HAM）的诊断标准。这些情况可能随后进展为HAM或构成一种中间临床形式：中间综合征（IS），即无症状HTLV-1携带者与完全性脊髓病患者之间的中间状态。因此，我们确定了HTLV-1无症状感染者和IS患者中HAM病例的发病率，以及临床/实验室相关标志物。本研究共纳入204例HTLV-1阳性患者，分为两组：第1组，包括145例无症状HTLV-1感染者（ASY）；第2组，包括59例在三个以上系统出现炎症性临床症状且前病毒载量（PVL）高的患者。在60个月的随访期内，年龄范围为47至79岁，最初诊断为IS的59例患者中有10例发展为HAM（iHAM），最初的145例ASY患者中有2例直接发展为HAM。所有组中女性更为常见。对于iHAM患者，年龄范围为20至72岁，平均年龄为53岁（±15标准差）。年龄较大与HAM的发生、较高的PVL和IS相关；然而，没有任何特定症状或临床体征与iHAM风险相关。总之，IS病例可能是HAM发展的早期阶段。这些发现表明，我们队列中的发病率高于先前报道。
