Incomplete myelopathy and human T cell lymphotropic virus type-1 (HTLV-1)
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This was a cross-sectional prospective study. We performed a multivariate statistical analysis of the neurological signs and symptoms of patients infected with human T cell lymphotropic virus type 1 (HTLV-1) in an attempt to separate them into distinct groups and identify clinical-neurological manifestations that could differentiate the various profiles. The study was performed in the city of Belém (state of Pará), located in the Amazon region of Brazil, from 2014 to 2016. We determined muscle strength and tone, reflexes, sensations, sphincter function, gait, and the Expanded Disability Status Scale score among individuals with HTLV-I. We then used exploratory statistical methods in an attempt to find different profiles and establish distinct groups. We analyzed 60 patients with HTLV-1. The filtering of the data, performed with mixed PCA, gave rise to a streamlined database with the most informative data and suggested the formation of three statistically distinct groups: asymptomatic carriers (AC), mono/oligosymptomatic (MOS), and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSPd), AC and MOS (p = 0.002), AC and HAM/TSPd (p < 0.001), and HAM/TSPd and MOS (p = 0.001). The subsequent cluster analysis confirmed the formation of three clusters. The classification and regression tree demonstrated that altered gait was the most important variable for the classification of an individual with HAM/TSPd and that, in the absence of this impairment, hyperreflexia characterized MOS. The present study was able to separate patients infected by HTLV-1 into three clinical groups (AC, HAM/TSPd, and MOS) and identify clinical manifestations that could differentiate the various patient groups.
KeywordsHTLV-I-associated myelopathy HTLV-I-associated myelopathy-tropical spastic paraparesis HTLV-I Diagnoses and examinations HAM/TSP
This work was supported by the Brazilian National Council for Scientific and Technological Development (CNPq number 457393/2014-9).
Compliance with ethical standards
The local human research ethics committee approved the present study, and all participants signed a statement of informed consent.
Conflict of interest
The authors declare that they have no conflict of interest.
- Biswas HH, Engstrom JW, Kaidarova Z, Garratty G, Gibble JW, Newman BH, Smith JW, Ziman A, Fridey JL, Sacher RA, Murphy EL (2009) Neurologic abnormalities in HTLV-I- and HTLV-II-infected individuals without overt myelopathy. Neurology 73(10):781–789. https://doi.org/10.1212/WNL.0b013e3181b6bba9 CrossRefPubMedPubMedCentralGoogle Scholar
- Campbell WW, Dejong RN (2013) Dejong’s the neurologic examination, 7th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
- De Castro-Costa CM, Araújo AQ, Barreto MM, Takayanagui OM, Sohler MP, da Silva EL, de Paula SM, Ishak R, Ribas JG, Rovirosa LC, Carton H, Gotuzzo E, Hall WW, Montano S, Murphy EL, Oger J, Remondegui C, Taylor GP (2006) Proposal for diagnostic criteria of tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). AIDS Res Hum Retrovir 22(10):931–935CrossRefGoogle Scholar
- Dias GA, Yoshikawa GT, Koyama RV, Fujihara S, Martins LC, Medeiros R, Quaresma JA, Fuzii HT (2016) Neurological manifestations in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis in the Amazon. Spinal Cord 54(2):154–157. https://doi.org/10.1038/sc.2015.112 CrossRefPubMedGoogle Scholar
- Gotuzzo E, Cabrera J, Deza L, Verdonck K, Vandamme AM, Cairampoma R, Vizcarra D, Cabada M, Narvarte G, De las Casas C (2004) Clinical characteristics of patients in Peru with human T cell lymphotropic virus type 1-associated tropical spastic paraparesis. Clin Infect Dis 39(7):939–944CrossRefGoogle Scholar
- Hill MO, Smith AJE (1976) Principal component analysis of taxonomic data with multi-state discrete characters. Taxon. International Association for Plant Taxonomy (IAPT) 25:249–255Google Scholar
- Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70Google Scholar
- Maechler M, Rousseeuw P, Struyf A, Hubert M, Hornik K (2016) cluster: cluster analysis basics and extensions. R package version 2.0.4Google Scholar
- Medical Research Council of the United Kingdom (1978) Aids to examination of the peripheral nervous system: memorandum, no.45. Palo Alto, California: Pedragon HouseGoogle Scholar
- Miyazaki M, Sakakima H, Goto T, Kiyama R, Matsuzaki T, Ijiri K, Yoshida Y (2011) Isokinetic trunk and knee muscle strengths and gait performance in walking patients with T-cell lymphotropic virus type 1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP). J Jpn Phys Ther Assoc 14(1):19–26. https://doi.org/10.1298/jjpta.Vol14_003 CrossRefPubMedPubMedCentralGoogle Scholar
- Sebastien L, Josse J, Husson F (2008) FactoMineR: an R package for multivariate analysis. J Stat Softw 25(1):1–18Google Scholar
- Tanajura D, Castro N, Oliveira P, Neto A, Muniz A, Carvalho NB, Orge G, Santos S, Glesby MJ, Carvalho EM (2015) Neurological manifestations in human T-cell lymphotropic virus type 1 (HTLV-1)-infected individuals without HTLV-1-associated myelopathy/tropical spastic paraparesis: a longitudinal cohort study. Clin Infect Dis 61(1):49–56. https://doi.org/10.1093/cid/civ229 CrossRefPubMedPubMedCentralGoogle Scholar
- World Health Organization. Regional Office for the Western Pacific. (1988). Scientific group on HTLV-I infections and associated diseases, Kagoshima, Japan 10–15 December 1988 : report. Manila: WHO Regional Office for Western PacificGoogle Scholar