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Incomplete myelopathy and human T cell lymphotropic virus type-1 (HTLV-1)

  • Roberta Vilela Lopes Koyama
  • Gilberto Toshimitsu Yoshikawa
  • Satomi Fujihara
  • George Alberto da Silva Dias
  • Rodrigo Rodrigues Virgolino
  • Anderson Raiol Rodrigues
  • Rita Medeiros
  • Juarez Antônio Simões Quaresma
  • Hellen Thaís Fuzii
Article
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Abstract

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.

Keywords

HTLV-I-associated myelopathy HTLV-I-associated myelopathy-tropical spastic paraparesis HTLV-I Diagnoses and examinations HAM/TSP 

Notes

Funding

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.

References

  1. 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
  2. Campbell WW, Dejong RN (2013) Dejong’s the neurologic examination, 7th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  3. Caskey MF, Morgan DJ, Porto AF, Giozza SP, Muniz AL, Orge GO, Travassos MJ, Barrón Y, Carvalho EM, Glesby MJ (2007) Clinical manifestations associated with HTLV type I infection: a cross-sectional study. AIDS Res Hum Retrovir 23(3):365–371CrossRefGoogle Scholar
  4. Champs AP, Passos VM, Barreto SM, Vaz LS, Ribas JG (2010) HTLV-1 associated myelopathy: clinical and epidemiological profile in a 10-year case series study. Rev Soc Bras Med Trop 43(6):668–672CrossRefGoogle Scholar
  5. 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
  6. 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
  7. Dray S, Dufour AB (2007) The ade4 package: implementing the duality diagram for ecologists. J Stat Softw 22(4):1–20CrossRefGoogle Scholar
  8. Franzoi AC, Araújo AQ (2007) Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP). Spinal Cord 45(1):64–68CrossRefGoogle Scholar
  9. Gessain A, Barin F, Vernant JC, Gout O, Maurs L, Calender A, de Thé G (1985) Antibodies to human T-lymphotropic virus type-I in patients with tropical spastic paraparesis. Lancet 2(8452):407–410CrossRefGoogle Scholar
  10. 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
  11. 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
  12. Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70Google Scholar
  13. Hothorn T, Hornik K, Zeileis A (2006) Unbiased recursive partitioning: a conditional inference framework. J Computat and Graph Stat 15(3):651–674CrossRefGoogle Scholar
  14. Kaplan JE, Osame M, Kubota H, Igata A, Nishitani H, Maeda Y, Khabbaz RF, Janssen RS (1990) The risk of development of HTLV-I-associated myelopathy/tropical spastic paraparesis among persons infected with HTLV-I. J Acquir Immune Defic Syndr 3(11):1096–1101PubMedGoogle Scholar
  15. Kiers HAL (1991) Simple structure in component analysis techniques for mixtures of qualitative and quantitative variables. Psychometrika 56:197–212CrossRefGoogle Scholar
  16. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452CrossRefGoogle Scholar
  17. MacCallum RC, Widaman KF, Preacher KJ, Hong S (2001) Sample size in factor analysis: the role of model error. Multivar Behav Res 36:611–637CrossRefGoogle Scholar
  18. Maechler M, Rousseeuw P, Struyf A, Hubert M, Hornik K (2016) cluster: cluster analysis basics and extensions. R package version 2.0.4Google Scholar
  19. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R (2016) Bowel disorders. Gastroenterology S0016-5085(16):00222–00225.  https://doi.org/10.1053/j.gastro.2016.02.031 CrossRefGoogle Scholar
  20. 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
  21. 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
  22. Murphy EL, Fridey J, Smith JW, Engstrom J, Sacher RA, Miller K, Gibble J, Stevens J, Thomson R, Hansma D, Kaplan J, Khabbaz R, Nemo G (1997) HTLV-associated myelopathy in a cohort of HTLV-I and HTLV-II-infected blood donors. The REDS investigators. Neurology 48(2):315–320CrossRefGoogle Scholar
  23. Poetker SK, Porto AF, Giozza SP, Muniz AL, Caskey MF, Carvalho EM, Glesby MJ (2011) Clinical manifestations in individuals with recent diagnosis of HTLV type I infection. J Clin Virol 51(1):54–58.  https://doi.org/10.1016/j.jcv.2011.02.004 CrossRefPubMedPubMedCentralGoogle Scholar
  24. R Core Team (2016) R: a language and environment for statistical computing. In: R Foundation for statistical computing. Austria. URL, Vienna https://www.R-project.org/ Google Scholar
  25. Sebastien L, Josse J, Husson F (2008) FactoMineR: an R package for multivariate analysis. J Stat Softw 25(1):1–18Google Scholar
  26. Shoeibi A, Etemadi M, Moghaddam Ahmadi A, Amini M, Boostani R (2013) “HTLV-I infection” twenty-year research in Neurology Department of Mashhad University of Medical Sciences. Iran J Basic Med Sci 16(3):202–207PubMedPubMedCentralGoogle Scholar
  27. Slater CM, Ribeiro LC, Puccioni-Sohler M (2012) Difficulties in HAM/TSP diagnosis. Arq Neuropsiquiatr 70(9):686–690CrossRefGoogle Scholar
  28. 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
  29. Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34(2):119–126CrossRefGoogle Scholar
  30. Verdonck K, González E, Van Dooren S, Vandamme AM, Vanham G, Gotuzzo E (2007) Human T-lymphotropic virus 1: recent knowledge about an ancient infection. Lancet Infect Dis 7(4):266–281CrossRefGoogle Scholar
  31. 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

Copyright information

© Journal of NeuroVirology, Inc. 2018

Authors and Affiliations

  • Roberta Vilela Lopes Koyama
    • 1
  • Gilberto Toshimitsu Yoshikawa
    • 2
  • Satomi Fujihara
    • 3
  • George Alberto da Silva Dias
    • 1
  • Rodrigo Rodrigues Virgolino
    • 3
  • Anderson Raiol Rodrigues
    • 3
  • Rita Medeiros
    • 3
  • Juarez Antônio Simões Quaresma
    • 3
  • Hellen Thaís Fuzii
    • 3
  1. 1.Center of Biological and Health SciencesPará State UniversityMarco, BelemBrazil
  2. 2.Institute of Health SciencesFederal University of ParáUmarizal, BelemBrazil
  3. 3.Tropical Medicine GroupFederal University of ParáUmarizal, BelemBrazil

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