Elsevier

The Journal of Pediatrics

Volume 155, Issue 5, November 2009, Pages 700-706
The Journal of Pediatrics

Original Article
Early Neurologic Abnormalities Associated with Human T-Cell Lymphotropic Virus Type 1 Infection in a Cohort of Peruvian Children

https://doi.org/10.1016/j.jpeds.2009.05.027Get rights and content

Objective

Because human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) may occur in some children infected with HTLV-1, we sought to determine the prevalence of neurologic abnormalities and any associations of neurologic abnormalities with infective dermatitis in these children.

Study design

We enrolled 58 children infected with HTLV-1 and 42 uninfected children (ages 3 to 17) of mothers infected with HTLV-1 in a family study in Lima, Peru. We obtained medical and developmental histories, surveyed current neurologic symptoms, and conducted a standardized neurologic examination without prior knowledge of HTLV-1 status.

Results

HTLV-1 infection was associated with reported symptoms of lower extremity weakness/fatigue (odds ratio [OR], 6.1; confidence interval [CI], 0.7 to 281), lumbar pain (OR, 1.7; 95% CI, 0.4 to 8), and paresthesia/dysesthesia (OR, 2.6; CI, 0.6 to 15.8). HTLV-1 infection was associated with lower-extremity hyperreflexia (OR, 3.1; CI, 0.8 to 14.2), ankle clonus (OR, 5.0; CI, 1.0 to 48.3), and extensor plantar reflex (OR undefined; P = .2). Among children infected with HTLV-1, a history of infective dermatitis was associated with weakness (OR, 2.7; CI, 0.3 to 33), lumbar pain (OR, 1.3; CI, 0.2 to 8), paresthesia/dysesthesia (OR, 2.9; CI, 0.5 to 20), and urinary disturbances (OR, 5.7; CI, 0.5 to 290).

Conclusions

Abnormal neurologic findings were common in Peruvian children infected with HTLV-1, and several findings were co-prevalent with infective dermatitis. Pediatricians should monitor children infected with HTLV-1 for neurologic abnormalities.

Section snippets

Methods

We conducted standardized, blinded neurological evaluations of children, with and without HTLV-1 infection, of mothers infected with HTLV-1 in Lima, Peru, where the estimated prevalence of HTLV-1 infection in pregnant women is 1.7%.37 Study participants were drawn from an ongoing HTLV-1 family cohort study (>600 families) at the Institute of Tropical Medicine, “Alexander von Humboldt” in Lima,2 a cohort composed primarily of families of patients who have visited or been referred to the hospital

Results

According to records for >600 HTLV-1 cohort families, 104 families had children eligible for this study. Of these, 66 families were reached and agreed to participate, ultimately yielding 103 eligible study participants from 63 families: 58 children were infected with HTLV-1 and 42 children were uninfected (and 3 were excluded based on indeterminate serological results). None had previously-recognized HAM/TSP. Age and sex profiles are similar for HTLV-1–infected and uninfected subject groups (

Discussion

We found that childhood HTLV-1 infection was associated with lower pyramidal tract signs and neuromuscular symptoms consistent with early HAM/TSP. Nearly all of the signs and symptoms evaluated were present more frequently in children with infection, and, although differences for some infrequent findings may have been due to chance, overall there is a significant association of infection with an abnormal examination. The association of HTLV-1 infection with lower extremity hyperreflexia is

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      TSP/HAM mainly occurs in adults, with a mean age at onset of 40–50 years. However, some rare cases of TSP/HAM occurring in children have been reported, especially in Peru and Brazil (Kendall et al., 2009). In contrast to ATLL (male/female ratio = 1.4), TSP/HAM is more common in women than in men at all ages, with a sex ratio of 0.4.

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    Supported by the Directorate-General for Development Cooperation of the Belgian Government through a Framework Agreement with the Institute of Tropical Medicine in Antwerp (DGOS-II); the Flemish Interuniversity Council Programme (VLIR); Vanderbilt University School of Medicine Emphasis Program; the Vanderbilt-Meharry Center for AIDS Research (NIH grant P30AI054999); and the Vanderbilt-Meharry Framework Program for Global Health (NIH grant R25TW007766).

    The authors declare no potential conflicts of interest.

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