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Clinical features of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in northeast Iran

Abstract

This study aimed to introduce clinical manifestations of patients in northeast Iran with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and describe the epidemiological features, as well as risk factors for HTLV-1 infection. This is a cross-sectional study of HTLV-1 infected cases and HAM/TSP patients referred by outpatient neurology clinics as well as Mashhad Blood Transfusion Center from 2005 to 2010. The study comprises 513 cases, including 358 healthy carriers (HCs) and 145 HAM/TSP patients. The majority of carriers were male (73.5 %), whereas 67.6 % of HAM/TSP sufferers were female (P < 0.001). The mean age of HAM/TSP patients and HCs was 45.9 ± 13.6 and 39.5 ± 11.58 years, respectively (P < 0.001). The history of transfusion, surgery, hospitalization and cupping was observed in a significant greater number of HAM/TSP patients than the HCs (P < 0.001, P < 0.001, P < 0.001 and P = 0.029, respectively). Gait disturbance was the most common complaint in HAM/TSP patients (72.4 %). This research develops an HTLV-1 data registry in an endemic area such as Mashhad which can serve useful purposes, including evaluation of clinical and laboratory characteristics of HAM/TSP patients and epidemiological data of HTLV-1-infected cases.

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References

  1. Lepoutre V, Jain P, Quann K, Wigdahl B, Khan ZK (2009) Role of resident CNS cell populations in HTLV-1-associated neuroinflammatory disease. Front Biosci 14:1152–1168

    Article  CAS  Google Scholar 

  2. Barmak K, Harhaj E, Grant C, Alefantis T, Wigdahl B (2003) Human T cell leukemia virus type I-induced disease: pathways to cancer and neurodegeneration. Virology 308(1):1–12

    PubMed  Article  CAS  Google Scholar 

  3. Taylor JM, Nicot C (2008) HTLV-1 and apoptosis: role in cellular transformation and recent advances in therapeutic approaches. Apoptosis 13(6):733–747

    PubMed  Article  CAS  Google Scholar 

  4. Araujo AQ, Leite AC, Lima MA, Silva MT (2009) HTLV-1 and neurological conditions: when to suspect and when to order a diagnostic test for HTLV-1 infection? Arq Neuropsiquiatr 67(1):132–138

    PubMed  Article  Google Scholar 

  5. Osame M, Usuku K, Izumo S, Ijichi N, Amitani H, Igata A, Matsumoto M, Tara M (1986) HTLV-I associated myelopathy, a new clinical entity. Lancet 1(8488):1031–1032

    PubMed  Article  CAS  Google Scholar 

  6. La GL, Manns A, Fletcher V, Derm D, Carberry C, Hanchard B, Maloney EM, Cranston B, Williams NP, Wilks R, Kang EC, Blattner WA (1998) Clinical, pathologic, and immunologic features of human T-lymphotrophic virus type I-associated infective dermatitis in children. Arch Dermatol 134(4):439–444

    Article  Google Scholar 

  7. Buggage RR (2003) Ocular manifestations of human T-cell lymphotropic virus type 1 infection. Curr Opin Ophthalmol 14(6):420–425

    PubMed  Article  Google Scholar 

  8. Verdonck K, Gonzalez E, Van DS, Vandamme AM, Vanham G, Gotuzzo E (2007) Human T-lymphotropic virus 1: recent knowledge about an ancient infection. Lancet Infect Dis 7:266–281

    PubMed  Article  CAS  Google Scholar 

  9. Leite AC, Mendonca GA, Serpa MJ, Nascimento OJ, Araujo AQ (2003) Neurological manifestations in HTLV-I-infected blood donors. J Neurol Sci 214(1–2):49–56

    PubMed  Article  Google Scholar 

  10. Cooper SA, van der Loeff MS, Taylor GP (2009) The neurology of HTLV-1 infection. Pract Neurol 9(1):16–26

    PubMed  Article  Google Scholar 

  11. Gessain A, Mahieux R (2000) Epidemiology, origin and genetic diversity of HTLV-1 retrovirus and STLV-1 simian affiliated retrovirus. Bull Soc Pathol Exot 93:163–171

    PubMed  CAS  Google Scholar 

  12. Nakamura T (2009) HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP): the role of HTLV-I-infected Th1 cells in the pathogenesis, and therapeutic strategy. Folia Neuropathol 47(2):182–194

    PubMed  CAS  Google Scholar 

  13. Popovic M, Sarin PS, Robert-Gurroff M, Kalyanaraman VS, Mann D, Minowada J, Gallo RC (1983) Isolation and transmission of human retrovirus (human t-cell leukemia virus). Science 219(4586):856–859

    PubMed  Article  CAS  Google Scholar 

  14. Achiron A, Pinhas-Hamiel O, Doll L, Djaldetti R, Chen A, Ziv I, Avni A, Frankel G, Melamed E, Shohat B (1993) Spastic paraparesis associated with human T-lymphotropic virus type I: a clinical, serological, and genomic study in Iranian-born Mashhadi Jews. Ann Neurol 34:670–675

    PubMed  Article  CAS  Google Scholar 

  15. Meytes D, Schochat B, Lee H, Nadel G, Sidi Y, Cerney M, Swanson P, Shaklai M, Kilim Y, Elgat M (1990) Serological and molecular survey for HTLV-I infection in a high-risk Middle Eastern group. Lancet 336:1533–1535

    PubMed  Article  CAS  Google Scholar 

  16. Sidi Y, Meytes D, Shohat B, Fenig E, Weisbort Y, Lee H, Pinkhas J, Rosenblatt JD (1990) Adult T-cell lymphoma in Israeli patients of Iranian origin. Cancer 65:590–593

    PubMed  Article  CAS  Google Scholar 

  17. Farid R, Etemadi M, Baradaran H, Nikbin B (1993) Seroepidemiology and virology of HTLV-1 in the city of Mashhad, northeastern Iran. Serodiagn Immunother Infect Disease 5:251–252

    Article  Google Scholar 

  18. Safai B, Huang JL, Boeri E, Farid R, Raafat J, Schutzer P, Ahkami R, Franchini G (1996) Prevalence of HTLV type I infection in Iran: a serological and genetic study. AIDS Res Hum Retroviruses 12:1185–1190

    PubMed  Article  CAS  Google Scholar 

  19. Rezvan H, Ahmadi J, Farhadi M (1996) A cluster of HTLV-I infection in northeastern of Iran. Transfus Today 27:8–9

    Google Scholar 

  20. Abbaszadegan MR, Gholamin M, Tabatabaee A, Farid R, Houshmand M, Abbaszadegan M (2003) Prevalence of human T-lymphotropic virus type 1 among blood donors from Mashhad, Iran. J Clin Microbiol 41:2593–2595

    PubMed  Article  Google Scholar 

  21. Tarhini M, Kchour G, Zanjani DS, Rafatpanah H, Otrock ZK, Bazarbachi A, Farid R (2009) Declining tendency of human T-cell leukaemia virus type I carrier rates among blood donors in Mashhad, Iran. Pathology 41:498–499

    PubMed  Article  Google Scholar 

  22. Rafatpanah H, Hedayati-Moghaddam, Fathimoghadam F, Bidkhori HR, Shamsian SK, Ahmadi S, Sohgandi L, Azarpazhooh, Rezaee SA, Farid R, Bazarbachi A (2011) High prevalence of HTLV-I infection in Mashhad, Northeast Iran: a population-based seroepidemiology survey. J Clin Virol 52:172–176

    PubMed  Article  Google Scholar 

  23. Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC, Murphy EL (2005) Global epidemiology of HTLV-I infection and associated diseases. Oncogene 24:6058–6068

    PubMed  Article  CAS  Google Scholar 

  24. Voevodin A, al-Mufti S, Farah S, Khan R, Miura T (1995) Molecular characterization of human T-lymphotropic virus, type 1 (HTLV-1) found in Kuwait: close similarity with HTLV-1 isolates originating from Mashhad, Iran. AIDS Res Hum Retroviruses 11:1255–1259

    PubMed  Article  CAS  Google Scholar 

  25. Denic S, Nolan P, Doherty J, Garson J, Tuke P, Tedder R (1990) HTLV-I infection in Iraq. Lancet 336:1135–1136

    PubMed  Article  CAS  Google Scholar 

  26. Voevodin A, Gessain A (1997) Common origin of human T-lymphotropic virus type-I from Iran, Kuwait, Israel, and La Reunion Island. J Med Virol 52:77–82

    PubMed  Article  CAS  Google Scholar 

  27. al-Mufti S, Voevodin A, Ahmed S, Al-Hamdan S, Al-Bisher AA (1997) Prevalence of human T-cell lymphotropic virus type I infection among volunteer blood donors in Kuwait. J Acquir Immune Defic Syndr Hum Retrovirol 15:88–90

    PubMed  CAS  Google Scholar 

  28. Miller M, Achiron A, Shaklai M, Stark P, Maayan S, Hannig H, Hunsmann G, Bodemer W, Shohat B (1998) Ethnic cluster of HTLV-I infection in Israel among the Mashhadi Jewish population. J Med Virol 56:269–274

    PubMed  Article  CAS  Google Scholar 

  29. Farid R, Shirdel A, Etemadi M, Rafatpanah H, Baradaran H, Farid R, Nikbin B (1999) Phylogenetic of Human T-cell Lymphotropic Virus Type I in Iranians Born in Mashhad. AIM 2:20–24

    Google Scholar 

  30. Osame M (1990) Review of WHO Kagoshima meeting and diagnostic guidelines for HAM/TSP. In: Blattner WA (ed) Human retrovirology: HTLV. Raven Press, New York, pp 191–197

    Google Scholar 

  31. De Castro-Costa CM, Araujo 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 Retroviruses 22:931–935

    PubMed  Article  Google Scholar 

  32. Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, Bittner C, Fialka-Moser V (2008) Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 40:665–671

    PubMed  Article  Google Scholar 

  33. Bohannon RW, Smith MB (1987) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67:206–207

    PubMed  CAS  Google Scholar 

  34. Izumo S, Goto I, Itoyama Y, Okajima T, Watanabe S, Kuroda Y, Araki S, Mori M, Nagataki S, Matsukura S, Akamine T, Nakagawa M, Yamamoto I, Osame M (1996) Interferon-alpha is effective in HTLV-I-associated myelopathy: a multicenter, randomized, double-blind, controlled trial. Neurology 46:1016–1021

    PubMed  Article  CAS  Google Scholar 

  35. Izumo S, Usuku K, Osame M, Arimura K, Igata A (1988) Effect of alpha-interferon treatment on HTLV-1 associated myelopathy (HAM). Neurology 39:242

    Google Scholar 

  36. Dourado I, Alcantara LC, Barreto ML, da Gloria TM, Galvao-Castro B (2003) HTLV-I in the general population of Salvador, Brazil: a city with African ethnic and sociodemographic characteristics. J Acquir Immune Defic Syndr 34:527–531

    PubMed  Article  Google Scholar 

  37. Sanchez-Palacios C, Gotuzzo E, Vandamme AM, Maldonado Y (2003) Seroprevalence and risk factors for human T-cell lymphotropic virus (HTLV-I) infection among ethnically and geographically diverse Peruvian women. Int J Infect Dis 7:132–137

    PubMed  Article  CAS  Google Scholar 

  38. Dourado I, Andrade T, Galvao-Castro B (1998) HTLV-I in Northeast Brazil: differences for male and female injecting drug users. J Acquir Immune Defic Syndr Hum Retrovirol 19:426–429

    PubMed  Article  CAS  Google Scholar 

  39. Rouet F, Foucher C, Rabier M, Gawronski I, Taverne D, Chancerel B, Casman O, Strobel M (1999) Human T-lymphotropic virus type I among blood donors from Guadeloupe: donation, demographic, and biologic characteristics. Transfusion 39:639–644

    PubMed  Article  CAS  Google Scholar 

  40. Gotuzzo E, Cabrera J, Deza L, Verdonck K, Vandamme AM, Cairampoma R, Vizcarra D, Cabada M, Narvarte G, De las CC (2004) Clinical characteristics of patients in Peru with human T cell lymphotropic virus type 1-associated tropical spastic paraparesis. Clin Infect Dis 39:939–944

    PubMed  Article  CAS  Google Scholar 

  41. Plancoulaine S, Buigues RP, Murphy EL, van Beveren M, Pouliquen JF, Joubert M, Remy F, Tuppin P, Tortevoye P, de The G, Moreau JP, Gessain A (1998) Demographic and familial characteristics of HTLV-1 infection among an isolated, highly endemic population of African origin in French Guiana. Int J Cancer 76:331–336

    PubMed  Article  CAS  Google Scholar 

  42. Kendall EA, Gonzalez E, Espinoza I, Tipismana M, Verdonck K, Clark D, Vermund SH, Gotuzzo E (2009) Early neurologic abnormalities associated with human T-cell lymphotropic virus type 1 infection in a cohort of Peruvian children. J Pediatr 155:700–706

    PubMed  Article  Google Scholar 

  43. Kramer A, Maloney EM, Morgan OS, Rodgers-Johnson P, Manns A, Murphy EL, Larsen S, Cranston B, Murphy J, Benichou J (1995) Risk factors and cofactors for human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Jamaica. Am J Epidemiol 142:1212–1220

    PubMed  CAS  Google Scholar 

  44. 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 43:668–672

    PubMed  Article  Google Scholar 

  45. Franzoi AC, Araujo AQ (2007) Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP). Spinal Cord 45:64–68

    PubMed  Article  CAS  Google Scholar 

  46. Carod-Artal FJ, Mesquita HM, Ribeiro LS (2008) Neurological symptoms and disability in HTLV-1 associated myelopathy. Neurologia 23:78–84

    PubMed  CAS  Google Scholar 

  47. Martin F, Fedina A, Youshya S, Taylor GP (2010) A 15-year prospective longitudinal study of disease progression in patients with HTLV-1 associated myelopathy in the UK. J Neurol Neurosurg Psychiatry 81:1336–1340

    PubMed  Article  Google Scholar 

  48. Cruickshank JK, Rudge P, Dalgleish AG, Newton M, McLean BN, Barnard RO, Kendall BE, Miller DH (1989) Tropical spastic paraparesis and human T cell lymphotropic virus type 1 in the United Kingdom. Brain 112(Pt 4):1057–1090

    PubMed  Article  Google Scholar 

  49. Waragai M, Takaya Y, Hayashi M (1995) HTLV-I associated myelopathy (HAM) with cerebellar atrophy presenting a down-beat nystagmus. Rinsho Shinkeigaku 35:549–552

    PubMed  CAS  Google Scholar 

  50. Yoshida Y, Saiga T, Takahashi H, Hara A (1998) Optic neuritis and human T-lymphotropic virus type 1-associated myelopathy: a case report. Ophthalmologica 212:73–76

    PubMed  Article  CAS  Google Scholar 

  51. Taki M, Nin F, Hasegawa T, Sakaguchi H, Suzuki T, Hisa Y, Azuma Y, Nakagawa M (2011) A case report of HTLV-I associated myelopathy presenting with cerebellar ataxia and nystagmus. Auris Nasus Larynx 38:411–414

    PubMed  Article  Google Scholar 

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Acknowledgments

The authors thank the personnel of the blood banks of Mashhad for helping us in this study. This study was supported by the Mashhad University of Medical Sciences.

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The authors declare that they have no conflict of interest.

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Correspondence to Mahmoud Reza Azarpazhooh.

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Shoeibi, A., Rafatpanah, H., Azarpazhooh, A. et al. Clinical features of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in northeast Iran. Acta Neurol Belg 113, 427–433 (2013). https://doi.org/10.1007/s13760-013-0194-6

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  • DOI: https://doi.org/10.1007/s13760-013-0194-6

Keywords

  • HTLV-1
  • Paraparesis, tropical spastic
  • Iran
  • Epidemiology