title: The cause of urinary symptoms among Human T Lymphotropic Virus Type I (HLTV-I) infected patients: a cross sectional study.
abstract: BACKGROUND
  HTLV-I infected patients often complain of urinary symptomatology. Epidemiological studies have suggested that these individuals have a higher prevalence and incidence of urinary tract infection (UTI) than seronegative controls. However, the diagnosis of UTI in these studies relied only on patient information and did not require confirmation by urine culture. The purpose of this study was to investigate the role of urinary tract infection (UTI) as the cause of urinary symptoms in HTLV-I infected patients.
  
  
  METHODS
  In this cross sectional study we interviewed, and cultured urine from, 157 HTLV-I seropositive individuals followed regularly at a specialized clinic. All patients were evaluated by a neurologist and classified according to the Expanded Disability Status Scale (EDSS). Urodynamic studies were performed at the discretion of the treating physician.
  
  
  RESULTS
  Sixty-four patients complained of at least one active urinary symptom but UTI was confirmed by a positive urine culture in only 12 of these patients (19%); the majority of symptomatic patients (81%) had negative urine cultures. To investigate the mechanism behind the urinary complaints in symptomatic individuals with negative urine cultures, we reviewed the results of urodynamic studies performed in 21 of these patients. Most of them (90.5%) had abnormal findings. The predominant abnormalities were detrusor sphincter hyperreflexia and dyssynergia, findings consistent with HTLV-I-induced neurogenic bladder. On a multivariate logistic regression, an abnormal EDSS score was the strongest predictor of urinary symptomatology (OR 9.87, 95% CI 3.465 to 28.116, P < 0.0001).
  
  
  CONCLUSIONS
  Urinary symptomatology suggestive of UTI is highly prevalent among HTLV-I seropositive individuals but true UTI is responsible for the minority of cases. We posit that the main cause of urinary symptoms in this population is neurogenic bladder. Our data imply that HLTV-I infected patients with urinary symptomatology should not be empirically treated for UTI but rather undergo urine culture; if a UTI is excluded, further investigation with urodynamic studies should be considered.
authors.affiliation: Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Rua Joao das Botas, s/n, 40110-160 Salvador, BA, Brazil. paulonrocha@alumni.duke.edu
authors.forename: Paulo N
authors.initials: PN
authors.lastname: Rocha
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Rehem
authors.forename: Juliana F
authors.initials: JF
authors.lastname: Santana
authors.forename: Neviton
authors.initials: N
authors.lastname: Castro
authors.forename: Andre L
authors.initials: AL
authors.lastname: Muniz
authors.forename: Katia
authors.initials: K
authors.lastname: Salgado
authors.forename: Heonir
authors.initials: H
authors.lastname: Rocha
authors.forename: Edgar M
authors.initials: EM
authors.lastname: Carvalho
mesh_terms: D001259:Ataxia / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D015490:HTLV-I Infections / Q000150:complications*; D015368:Human T-lymphotropic virus 1; D006801:Humans; D008297:Male; D008875:Middle Aged; D012021:Reflex, Abnormal; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*