title: Early neurologic abnormalities associated with human T-cell lymphotropic virus type 1 infection in a cohort of Peruvian children.
abstract: OBJECTIVE
  Because human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) may occur in some children infected with HTLV-1, we sought to determine the prevalence of neurologic abnormalities and any associations of neurologic abnormalities with infective dermatitis in these children.
  
  
  METHODS
  We enrolled 58 children infected with HTLV-1 and 42 uninfected children (ages 3 to 17) of mothers infected with HTLV-1 in a family study in Lima, Peru. We obtained medical and developmental histories, surveyed current neurologic symptoms, and conducted a standardized neurologic examination without prior knowledge of HTLV-1 status.
  
  
  RESULTS
  HTLV-1 infection was associated with reported symptoms of lower extremity weakness/fatigue (odds ratio [OR], 6.1; confidence interval [CI], 0.7 to 281), lumbar pain (OR, 1.7; 95% CI, 0.4 to 8), and paresthesia/dysesthesia (OR, 2.6; CI, 0.6 to 15.8). HTLV-1 infection was associated with lower-extremity hyperreflexia (OR, 3.1; CI, 0.8 to 14.2), ankle clonus (OR, 5.0; CI, 1.0 to 48.3), and extensor plantar reflex (OR undefined; P = .2). Among children infected with HTLV-1, a history of infective dermatitis was associated with weakness (OR, 2.7; CI, 0.3 to 33), lumbar pain (OR, 1.3; CI, 0.2 to 8), paresthesia/dysesthesia (OR, 2.9; CI, 0.5 to 20), and urinary disturbances (OR, 5.7; CI, 0.5 to 290).
  
  
  CONCLUSIONS
  Abnormal neurologic findings were common in Peruvian children infected with HTLV-1, and several findings were co-prevalent with infective dermatitis. Pediatricians should monitor children infected with HTLV-1 for neurologic abnormalities.
authors.affiliation: Institute for Global Health, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Kendall
authors.forename: Elsa
authors.initials: E
authors.lastname: González
authors.forename: Iván
authors.initials: I
authors.lastname: Espinoza
authors.forename: Martín
authors.initials: M
authors.lastname: Tipismana
authors.forename: Kristien
authors.initials: K
authors.lastname: Verdonck
authors.forename: Daniel
authors.initials: D
authors.lastname: Clark
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D017668:Age of Onset; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D015490:HTLV-I Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D009460:Neurologic Examination; D016017:Odds Ratio; D020335:Paraparesis / Q000175:diagnosis / Q000453:epidemiology*; D015493:Paraparesis, Tropical Spastic / Q000175:diagnosis / Q000453:epidemiology; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D014555:Urination Disorders / Q000175:diagnosis / Q000453:epidemiology