Clinical characteristics of patients in Peru with human T cell lymphotropic virus type 1-associated tropical spastic paraparesis.
BACKGROUND
Human T cell lymphotropic virus type 1 (HTLV-1) is associated with tropical spastic paraparesis (TSP). Peru is an area of endemicity for HTLV-1.


METHODS
All patients with suspected cases of TSP referred to our institute (Institute of Tropical Medicine Alexander von Humboldt, Lima, Peru) from 1989 through 2002 were interviewed and tested for HTLV-1. All patients with positive results were evaluated by an expert physician. Disease progression was defined as "rapid" if the time between TSP onset and inability to walk unaided was <2 years.


RESULTS
Among 165 patients enrolled, the symptoms and signs most frequently found were spasticity (in 97.5% of patients), hyperreflexia (95.4%), lower limb paresthesia (90.2%), pyramidal signs (82.6%), urinary complaints (82.0%), and lumbar pain (79.0%). Rapid progression was present in 21.5% of patients; mean age at TSP onset was higher among these patients than among slow progressors (P<.001). Severe spasticity, diminished vibratory sensation, and tremor were found more frequently among rapid progressors, compared with slow progressors.


CONCLUSIONS
HTLV-1--associated TSP is frequently diagnosed in areas of HTLV-1-endemicity. A subgroup of patients experiences rapid disease progression.
Institute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru. egh@upch.edu.pe
E
E
Gotuzzo
J
J
Cabrera
L
L
Deza
K
K
Verdonck
A-M
AM
Vandamme
R
R
Cairampoma
D
D
Vizcarra
M
M
Cabada
G
G
Narvarte
C
C
De las Casas
D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging; D005260:Female; D015368:Human T-lymphotropic virus 1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis; D015493:Paraparesis, Tropical Spastic / Q000175:diagnosis* / Q000453:epidemiology; D010568:Peru / Q000453:epidemiology; D012678:Sensation Disorders / Q000175:diagnosis; D014202:Tremor / Q000175:diagnosis