title: Human T cell lymphotropic virus type 1- associated infective dermatitis in KwaZulu Natal, South Africa.
abstract: BACKGROUND
  The Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (IDH), is a chronic relapsing dermatitis which usually presents in children older than 2 years. A total of 300 cases have been reported worldwide (Latin America, the Caribbean and only 5 from Senegal). Neither IDH, nor its complications have been reported from the rest of Africa. We aimed to examine the clinical and aetiological characteristics of IDH in a cohort of South African children.
  
  
  METHODS
  Attendees at the dermatology clinic at King Edward VIII Hospital, Durban underwent clinical examination. After obtaining consent those suspected of IDH had specimens taken for blood counts, immunoglobulins, serum protein electrophoresis, viral studies (including genotyping), skin swabs and stool examinations.
  
  
  RESULTS
  Nineteen of 60 suspected cases recruited over 3 years met the diagnostic criteria for IDH. The male-to-female ratio was 1:2; mean age 8 years (range 0.7 to 15). Dermatitis mostly affected the scalp (78.9%) and axilla (73.7%); fewer children had nasal crusting (47.4%). Mean Ig A, IgG and IgM were raised, at 3.52 g/l, 22.6 g/l and 1.38 g/l, respectively. The median CD4 cell count was 1958 cells/mm3. Viral genotyping of all tested samples were positive for the Cosmopolitan, Subtype A (HTLV-1a).
  
  
  CONCLUSIONS
  IDH is a distinct entity which also affects South Africans. Our patients were older at presentation and the majority did not present with nasal crusting as has been described in other countries.
authors.affiliation: Division of Dermatology; Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa. carol.hlela@uct.ac.za.
authors.forename: Carol
authors.initials: C
authors.lastname: Hlela
authors.forename: Natalie
authors.initials: N
authors.lastname: Graham
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Bhigjee
authors.forename: Graham P
authors.initials: GP
authors.lastname: Taylor
authors.forename: Nonhlanhla P
authors.initials: NP
authors.lastname: Khumalo
authors.forename: Anisa
authors.initials: A
authors.lastname: Mosam
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015490:HTLV-I Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D007136:Immunoglobulins / Q000032:analysis; D007223:Infant; D008297:Male; D012307:Risk Factors; D017193:Skin Diseases, Viral / Q000276:immunology / Q000473:pathology / Q000821:virology*; D013019:South Africa; D019562:Viral Load
chemical_list: D007136:Immunoglobulins