Jacquerioz Frederique A, La Rosa Mauricio, González-Lagos Elsa, Alvarez Carolina, Tipismana Martin, Luhmann Karen, Gotuzzo Eduardo
Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, Peru.
Pathogens. 2024 Aug 28;13(9):731. doi: 10.3390/pathogens13090731.
HTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a progressive non-remitting and incapacitating disease more frequently seen in women and with a patchy worldwide distribution. HAM/TSP develops in a small percentage of HTLV-1-infected individuals during their lifetime and etiologic factors for disease progression are still unclear. This study aims to describe the first case series of the progression of HAM/TSP in relation to pregnancy. Between January and March of 2012, we reviewed medical charts of women with HAM/TSP currently enrolled in the HTLV-1 cohort at the institute of tropical medicine of Cayetano Heredia University. Inclusion criteria included having a diagnosis of HAM/TSP according to the WHO guidelines and self-reported initial symptoms of HAM/TSP during pregnancy or within six months of delivery. Fifteen women reported having had symptoms compatible with HAM/TSP within four months of delivery. Among them, ten women had no symptoms before pregnancy and reported gait impairment after delivery. Five women with mild gait impairment before pregnancy noticed a worsening of their symptoms after delivery. Symptoms worsened after successive pregnancies. Recent studies have shown that HTLV-1 infection induces a strong T cell-mediated response and that the quality of this response plays a role in HAM/TSP pathogenesis. The relative immunosuppression during pregnancy, including blunting of the T-cell response, might allowed in certain women enhanced replication of HTLV-1 and disease progression in the postpartum. This is the first study looking specifically at HAM/TSP and pregnancy and the number of cases is remarkable. Further prospective studies of HTLV-1-infected women assessing immune markers during pregnancy are warranted. Breastfeeding was the main route of transmission. Strategies to prevent vertical transmission need to be evaluated in HTLV-1 endemic countries of Latin America.
人类嗜T淋巴细胞病毒1型相关脊髓病/热带痉挛性截瘫（HAM/TSP）是一种进行性、持续且使人丧失能力的疾病，在女性中更为常见，在全球呈散发性分布。HAM/TSP在一小部分感染人类嗜T淋巴细胞病毒1型（HTLV-1）的个体一生中发病，疾病进展的病因仍不清楚。本研究旨在描述首例与妊娠相关的HAM/TSP进展病例系列。2012年1月至3月，我们查阅了目前在卡耶塔诺·埃雷迪亚大学热带医学研究所HTLV-1队列中登记的HAM/TSP女性患者的病历。纳入标准包括根据世界卫生组织指南诊断为HAM/TSP，以及自我报告在孕期或分娩后6个月内出现HAM/TSP的初始症状。15名女性报告在分娩后4个月内出现与HAM/TSP相符的症状。其中，10名女性在怀孕前无症状，报告分娩后步态受损。5名怀孕前有轻度步态受损的女性注意到分娩后症状恶化。症状在连续妊娠后加重。最近的研究表明，HTLV-1感染会诱导强烈的T细胞介导反应，这种反应的质量在HAM/TSP发病机制中起作用。孕期相对的免疫抑制，包括T细胞反应减弱，可能使某些女性体内HTLV-1复制增加以及产后疾病进展。这是第一项专门研究HAM/TSP与妊娠的研究，病例数量可观。有必要对感染HTLV-1的女性进行进一步前瞻性研究，评估孕期的免疫标志物。母乳喂养是主要传播途径。在拉丁美洲HTLV-1流行国家，需要评估预防垂直传播的策略。
