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Open AccessArticle

Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis

Instituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
Hospital Cayetano Heredia, Lima 15102, Peru
Author to whom correspondence should be addressed.
Pathogens 2020, 9(6), 450;
Received: 15 April 2020 / Revised: 1 June 2020 / Accepted: 5 June 2020 / Published: 7 June 2020
(This article belongs to the Special Issue HTLV-1 Disease)
Background: Vertical transmission of HTLV-1 could lead to the early development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). This significantly affects quality of life and increases morbimortality. Objective: To describe the epidemiological and clinical characteristics of patients with early-onset HAM/TSP, defined as disease onset before 20 years of age. Methods: This is a retrospective study from an HTLV-1 clinical cohort between 1989 and 2019. We searched for medical records of patients with (1) diagnosis of HTLV-1 infection using two ELISA and/or one Western blot, (2) clinical diagnosis of HAM/TSP by neurological assessment, and (3) HAM/TSP symptom-onset before 20 years of age. Results: A total of 38 cases were identified in the cohort; 25 were female (66%). The median age of onset was 14 years old. 31 (82%) cases had HTLV-1 testing done among family members; 22 out of 25 tested mothers (88%) were HTLV-1 positive. Most patients (27/34) were breastfed for more than one year. Disease progression measured through EDSS and IPEC-1 showed an upward trend towards worsening spasticity with 18 patients (47%) eventually requiring mobility aids. Conclusions: Cases of early-onset HAM/TSP are not of rare occurrence, which translates into many more years of dependency, the use of mobility aids, and increased overall morbidity. View Full-Text
Keywords: HAM/TSP; myelopathy; paraparesis; chronic infection; inflammation HAM/TSP; myelopathy; paraparesis; chronic infection; inflammation
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Schwalb, A.; Pérez-Muto, V.; Cachay, R.; Tipismana, M.; Álvarez, C.; Mejía, F.; González-Lagos, E.; Gotuzzo, E. Early-Onset HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis. Pathogens 2020, 9, 450.

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