Dermatological findings in 3 generations of a family with a high prevalence of human T cell lymphotropic virus type 1 infection in Brazil.
BACKGROUND
Dermatologic manifestations are quite common in patients with adult T cell leukemia and lymphoma and patients with myelopathy and/or tropical spastic paraparesis associated with human T cell lymphotropic virus type 1 (HTLV-1). The aim of this study was to investigate dermatological findings presented by 30 members of a Brazilian family, half of whom are infected with HTLV-1 (as confirmed by enzyme-linked immunosorbent assay and Western blot).


METHODS
The subjects underwent dermatologic examination and laboratory assessment, which included the search for the HTLV-1 genome in peripheral blood mononuclear cells (PBMCs) by qualitative and semiquantitative polymerase chain reaction (PCR) and in skin samples by nested qualitative PCR and immunofluorescence assay.


RESULTS
We found that cases of xerotic dermatological alterations, including 3 cases of acquired ichthyosis, were more frequent among the infected patients (7 cases vs. none among the uninfected individuals; P=.0063). Other lesions observed in this group included impetigo, scabies, epidermal nevus, herpes zoster scar, rosacea, and juvenile acne. One HTLV-1-infected individual presented with concurrently acquired ichthyosis, impetigo, scabies, dermatophytosis, and seborrheic dermatitis. The PCR performed on PBMCs and skin samples from 24 patients confirmed the serological results in all cases. Additionally, the HTLV-1 proviral load was higher in patients with >1 skin lesion. Finally, HTLV-1 could be identified in the skin by immunofluorescence assay, which, by use of PCR as the gold standard, showed a sensitivity and specificity of 61.5% and 100%, respectively.


CONCLUSIONS
Altogether, these clinical and laboratory findings point to an HTLV-1 tropism toward the skin, even in HTLV-1 carriers without adult T cell leukemia/lymphoma or HTLV-1-associated myelopathy and/or tropical spastic paraparesis.
Nobre
Vandack
V
Infectious Diseases Branch, Federal University of Minas Gerais, Minas Gerais, Brazil. vandack@gmail.com
Guedes
Antônio Carlos
AC
Martins
Marina Lobato
ML
Barbosa-Stancioli
Edel Figueiredo
EF
Serufo
José Carlos
JC
Proietti
Fernando Augusto
FA
Ribas
João Gabriel
JG
Ferreira
Cibele Eponina Sanchez
CE
Lambertucci
José Roberto
JR
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002353:Carrier State / Q000821:virology; D005192:Family Health; D005260:Female; D015490:HTLV-I Infections / Q000453:epidemiology* / Q000503:physiopathology; D015368:Human T-lymphotropic virus 1; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000209:etiology; D008297:Male; D015493:Paraparesis, Tropical Spastic / Q000209:etiology; D016133:Polymerase Chain Reaction; D012871:Skin Diseases / Q000453:epidemiology / Q000503:physiopathology