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McGill NK, Vyas J, Shimauchi T, Tokura Y, Piguet V. HTLV-1-associated infective dermatitis: updates on the pathogenesis. Exp Dermatol 2012; 21:815-21. [DOI: 10.1111/exd.12007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 12/12/2022]
Affiliation(s)
- Neilia-Kay McGill
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
| | - Jui Vyas
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
| | - Takatoshi Shimauchi
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Vincent Piguet
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
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Lee R, Schwartz RA. Human T-lymphotrophic virus type 1–associated infective dermatitis: A comprehensive review. J Am Acad Dermatol 2011; 64:152-60. [DOI: 10.1016/j.jaad.2009.10.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/09/2009] [Accepted: 10/10/2009] [Indexed: 12/31/2022]
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Nascimento MCF, Primo J, Bittencourt A, Siqueira I, de Fátima Oliveira M, Meyer R, Schriefer A, Santos SB, Carvalho EM. Infective dermatitis has similar immunological features to human T lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis. Clin Exp Immunol 2009; 156:455-62. [PMID: 19438598 DOI: 10.1111/j.1365-2249.2008.03869.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Human T lymphotropic virus-type 1 (HTLV-1) is the causal agent of the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), adult T cell leukaemia/lymphoma and infective dermatitis associated with HTLV-1 (IDH). Over-production of proinflammatory cytokines and an increase in HTLV-1 proviral load are features of HAM/TSP, but the immunological basis of IDH has not been established. In addition to severe cutaneous manifestations, the importance of IDH relies on the observation that up to 30% of children with IDH develop HAM/TSP in childhood and adolescence. In this study we determined the immune response in patients with IDH measuring interleukin (IL)-4, IL-5, IL-10, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha levels as well as the HTLV-1 proviral load. Additionally, regulatory cytokines and anti-cytokines were added to cultures to evaluate the ability of these molecules to down-modulate TNF-alpha and IFN-gamma synthesis. HTLV-1 carriers and patients with HAM/TSP served as controls. TNF-alpha and IFN-gamma levels were higher in IDH than in HTLV-1 carriers. There was no difference in IFN-gamma and TNF-alpha concentrations in IDH and HAM/TSP patients. There was a tendency for higher IL-4 mRNA expression and immunoglobulin E (IgE) levels in IDH than in HTLV-1 carriers, but the difference did not reach statistical significance. The HTLV-1 proviral load was significantly higher in IDH patients than in HTLV-1 carriers. IDH is characterized by an exaggerated Th1 immune response and high HTLV-1 proviral load. The similarities between the immunological response in patients with IDH and HAM/TSP and the high proviral load observed in IDH provide support that IDH is a risk factor for development of HAM/TSP.
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Affiliation(s)
- M C F Nascimento
- Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Nobre V, Guedes AC, Martins ML, Barbosa-Stancioli EF, Serufo JC, Proietti FA, Ribas JG, Ferreira CES, Lambertucci JR. Dermatological findings in 3 generations of a family with a high prevalence of human T cell lymphotropic virus type 1 infection in Brazil. Clin Infect Dis 2006; 43:1257-63. [PMID: 17051489 DOI: 10.1086/508177] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 07/13/2006] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Vandack Nobre
- Infectious Diseases Branch, Federal University of Minas Gerais, Minas Gerais, Brazil.
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Kwon H, Ogle L, Benitez B, Bohuslav J, Montano M, Felsher DW, Greene WC. Lethal cutaneous disease in transgenic mice conditionally expressing type I human T cell leukemia virus Tax. J Biol Chem 2005; 280:35713-22. [PMID: 16105841 DOI: 10.1074/jbc.m504848200] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Type I human T cell leukemia virus (HTLV-I) is etiologically linked with adult T cell leukemia, an aggressive and usually fatal expansion of activated CD4+ T lymphocytes that frequently traffic to skin. T cell transformation induced by HTLV-I involves the action of the 40-kDa viral Tax transactivator protein. Tax both stimulates the HTLV-I long terminal repeat and deregulates the expression of select cellular genes by altering the activity of specific host transcription factors, including cyclic AMP-responsive element-binding protein (CREB)/activating transcription factor, NF-kappaB/Rel, and serum response factor. To study initiating events involved in HTLV-I Tax-induced T cell transformation, we generated "Tet-off" transgenic mice conditionally expressing in a lymphocyte-restricted manner (EmuSR alpha promoter-enhancer) either wild-type Tax or mutant forms of Tax that selectively compromise the NF-kappaB (M22) or CREB/activating transcription factor (M47) activation pathways. Wild-type Tax and M47 Tax-expressing mice, but not M22-Tax expressing mice, developed progressive alopecia, hyperkeratosis, and skin lesions containing profuse activated CD4 T cell infiltrates with evidence of deregulated inflammatory cytokine production. In addition, these animals displayed systemic lymphadenopathy and splenomegaly. These findings suggest that Tax-mediated activation of NF-kappaB plays a key role in the development of this aggressive skin disease that shares several features in common with the skin disease occurring during the preleukemic stage in HTLV-I-infected patients. Of note, this skin disease completely resolved when Tax transgene expression was suppressed by administration of doxycycline, emphasizing the key role played by this viral oncoprotein in the observed pathology.
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Affiliation(s)
- Hakju Kwon
- Gladstone Institute of Virology and Immunology, San Francisco, California 94158, USA
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Oliveira MDFSPD, Brites C, Ferraz N, Magalhaes P, Almeida F, Bittencourt AL. Infective dermatitis associated with the human T cell lymphotropic virus type I in Salvador, Bahia, Brazil. Clin Infect Dis 2005; 40:e90-6. [PMID: 15889351 DOI: 10.1086/430064] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2004] [Accepted: 01/25/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Infective dermatitis associated with human T cell lymphotropic virus type I (HTLV-I) infection is a chronic, relapsing eczema of childhood. METHODS Children, their mothers, and their siblings underwent serological testing for HTLV-I. Epidemiological data were collected from all seropositive children and their family members, and clinical and dermatological examinations were performed. Laboratory studies, including skin culture, and histopathological analyses were also performed. The diagnosis of infective dermatitis associated with HTLV-I (IDH) was made according to previously established criteria. RESULTS All of the patients with cases that demonstrated clinical aspects of IDH were positive for HTLV-I. The median age of the children at the time of the first visit was 8.0 years (range, 2-14 years). The median duration of breastfeeding for 19 children was 22.5 months (range, 1-48 months). The lesions were erythematous, scaly, exudative, and crusted in all cases. The scalp, retroauricular areas, neck, and groin were the regions that were commonly affected. Cultures were positive for Staphylococcus aureus for 95% of the patients. The children were followed-up for a median of 3.0 years (range, 0.1-7 years), and 5 children developed HTLV-I-associated myelopathy/tropical spastic paraparesis. All of the children except 1 were treated with sulfamethoxazole-trimethoprim, and their lesions either improved greatly or completely disappeared. CONCLUSIONS The present study demonstrates the severity of IDH in Bahia and confirms that its diagnosis is based almost exclusively on clinical aspects of the disease. Serological testing for HTLV-I and careful follow-up is recommended for all children with chronic, relapsing, severe eczema in regions where HTLV-I is endemic.
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Nobre V, Guedes ACM, Proietti FA, Stanciolli E, Martins ML, Serufo JC, Antunes CM, Grossi MA, Lambertucci JR. [Dermatologic lesions in patients infected with the human T-cell lymphotropic virus type 1 (HTLV-1)]. Rev Soc Bras Med Trop 2005; 38:43-52. [PMID: 15717094 DOI: 10.1590/s0037-86822005000100009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Human T-cell Lymphotropic virus type I (HTLV-1) was the first human retrovirus described. Some time after its discovery a group of diseases were related to this virus, such as, adult T-cell leukemia lymphoma (ATLL), HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and HTLV-1 associated uveitis (HAU). In the nineties, HTLV-1 was associated to a severe eczema of children, called infective dermatitis (ID). Since then, several other skin manifestations have been observed in HTLV-1-infected individuals, particularly in patients with ATLL or HAM/TSP. However, according to some reports, dermatologic lesions are also common in asymptomatic HTLV-1 carriers. Besides ID, all other skin lesions reported are nonspecific. The aim of this review is to outline the dermatologic manifestations reported in HTLV-1 infected patients, emphasizing the clinical and epidemiological value of these findings.
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Affiliation(s)
- Vandack Nobre
- Serviço de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Clyti E, Reynier C, Couppie P, Kazanji M, Sainte-Marie D, Prevost G, Aznar C, Pradinaud R. [Infective dermatitis and recurrent strongyloidiasis in a child]. Ann Dermatol Venereol 2004; 131:191-3. [PMID: 15026748 DOI: 10.1016/s0151-9638(04)93569-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Infective dermatitis is a chronic childhood dermatosis, associated with HTLV-1 infection. We report the observation of a young Haitian girl in French Guyana. OBSERVATION An 8 year-old girl presented recurring dermatosis on the scalp and armpits since she was 2 years old. The initial clinical examination showed the presence of centro-facial micro-papules, associated with a nasal pyodermatitis. A bacteriological culture isolated a Staphylococcus aureus. Phenotypic analysis did not indicate any production of exfoliatin or leucocidin. Serologic tests for HTLV1 were positive. In addition, the child presented recurring symptomatic anguillulosis, despite numerous antihelmintic treatments. A clinical and parasitological cure was obtained with a monthly treatment of ivermectin. COMMENTS This is the first case of infective dermatitis reported in french Guyana. The clinical analysis that led to this diagnosis showed a minor form of this dermatosis. The phenotypic analysis of the Staphylococcus aureus isolated from the cutaneous lesions did not indicate any factors of virulence habitually associated with pyodermatitis in Guyana. This is the first case of chronic digestive anguillulosis (a parasitic complaint usually associated with an adult HTLV-1 infection) associated with an infective dermatitis.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon, BP 6006, 97306 Cayenne Cedex.
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Mahé A, Meertens L, Ly F, Sow PS, Diop CT, Samb ND, Diop OM, Valensi F, Gessain A. Human T-cell leukaemia/lymphoma virus type 1-associated infective dermatitis in Africa: a report of five cases from Senegal. Br J Dermatol 2004; 150:958-65. [PMID: 15149509 DOI: 10.1111/j.1365-2133.2004.05834.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infective dermatitis (ID) is a rare dermatological condition of childhood that has been linked to human T-cell leukaemia/lymphoma virus type 1 (HTLV-1). Most cases have been reported in the Caribbean. Although several million people are estimated to be infected by HTLV-1 in sub-Saharan Africa, no case of ID has been reported in this area. OBJECTIVES To identify and to describe cases of HTLV-1-associated ID in Senegal, West Africa. METHODS Over a 3-year period, a serological test for HTLV-1 was performed at a dermatological centre in Dakar, Senegal, in children who presented with a picture suggestive of ID. Complementary haematological, immunological and virological investigations were performed in infected children and in their mothers. RESULTS Five patients with typical HTLV-1-associated ID were identified, of ages 17, 5, 4, 3 and 3 years; two patients belonged to the same family. They all presented with repeated flares of superinfected dermatitis involving typical sites of ID (mainly the scalp, external ears, nares and eyelids), associated with nasal discharge, and less commonly with a nonspecific papular rash on the face or trunk. Although oral antibiotic therapy always gave effective control of the symptoms, recurrences were constant. A persisting dry dermatitis of the retroauricular folds was common between flares. Infection in the oldest patient was associated with a chronic adult T-cell leukaemia/lymphoma. The mothers of three patients, and the grandmother of another, were all infected by HTLV-1 strains belonging to the Cosmopolitan molecular subtype, with a perfect nucleotide identity of long-terminal repeat and env gp21 genomic regions within each family. CONCLUSIONS We present the clinical and virological features of the first reported African cases of HTLV-1-associated ID. When compared with data from the Caribbean, infectious features seemed particularly prominent. ID appears to be overlooked in sub-Saharan Africa, where it might be easily confused with common pyoderma. Breast feeding appears to be the origin of HTLV-1 contamination of the children.
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Affiliation(s)
- A Mahé
- Institut d'Hygiène Sociale, Dakar, Sengal.
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Araújo APQC, Fontenelle LMC, Pádua PAB, Maia Filho HS, Araújo ADQC. Juvenile human T lymphotropic virus type 1-associated myelopathy. Clin Infect Dis 2002; 35:201-4. [PMID: 12087528 DOI: 10.1086/341251] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2001] [Revised: 02/25/2002] [Indexed: 11/03/2022] Open
Abstract
We report the cases of 5 adolescents with human T lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis, acquired in all but 1 case from the mother. The first symptom in all patients was difficulty in running, which was present for many years before the final diagnosis was made. Follow-up showed an indolent progression, regardless of treatment strategy.
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Affiliation(s)
- Alexandra P Q C Araújo
- Child Neurology Unit, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 22640-100, Brazil.
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Maloney EM, Hisada M, Palmer P, Brooks K, Pate E, Wiktor SZ, Lagrenade L, Manns A. Human T cell lymphotropic virus type I-associated infective dermatitis in Jamaica: a case report of clinical and biologic correlates. Pediatr Infect Dis J 2000; 19:560-5. [PMID: 10877174 DOI: 10.1097/00006454-200006000-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- E M Maloney
- Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, USA.
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Abstract
The vertical transmission of the human T-cell lymphotropic virus type I (HTLV-I) occurs predominantly through breast-feeding. Since some bottle-fed children born to carrier mothers still remain seropositive with a frequency that varies from 3.3% to 12.8%, an alternative pathway of vertical transmission must be considered. The prevalence rate of vertical transmission observed in Japan varied from 15% to 25% in different surveys. In Brazil there is no evaluation of this form of transmission until now. However, it is known that in Salvador, Bahia, 0.7% to 0.88% of pregnant women of low socio-economic class are HTLV-I carriers. Furthermore the occurrence of many cases of adult T-cell leukemia/lymphoma and of four cases of infective dermatitis in Salvador, diseases directly linked to the vertical transmission of HTLV-I, indicates the importance of this route of infection among us. Through prenatal screening for HTLV-I and the refraining from breast-feeding a reduction of approximately 80% of vertical transmission has been observed in Japan. We suggest that in Brazil serologic screening for HTLV-I infection must be done for selected groups in the prenatal care: pregnant women from endemic areas, Japanese immigrants or Japanese descendents, intravenous drug users (IDU) or women whose partners are IDU, Human immunodeficiency virus carriers, pregnant women with promiscuous sexual behavior and pregnant women that have received blood transfusions in areas where blood donors screening is not performed. There are in the literature few reports demonstrating the vertical transmission of HTLV-II.
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Affiliation(s)
- A L Bittencourt
- Faculdade de Medicina, Universidade Federal da Bahia, Brasil.
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La Grenade L. HTLV-I-associated infective dermatitis: past, present, and future. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1996; 13 Suppl 1:S46-9. [PMID: 8797703 DOI: 10.1097/00042560-199600001-00009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Infective dermatitis (ID) of Jamaican children, a distinctive pattern of dermatitis first described in Jamaican children in 1966 was found to be associated with human T-cell lymphotropic virus type I (HTLV-I) infection in 1990. Since then, ID has been reported from other HTLV-I endemic areas. Further studies have confirmed the HTLV-I association and have demonstrated immunologic abnormalities in cellular and humoral immune systems as well as at the subcellular level. Viral genome has been detected in cultured skin biopsy material, and genetic factors may predispose people to the development of ID. Transmission of HTLV-I infection in ID appears to be from mother to infant via breast milk. Present therapy is with long-term antibiotics to control bacterial infection and hence the dermatitis. Complications are frequent and include crusted scabies, corneal opacities, chronic bronchiectasis, parasitic worm infestation, early death, and progression to more severe HTLV-I-associated disorders such as adult T-cell leukemia/lymphoma and HTLV-I-associated myelopathy/tropical spastic paraparesis. Future studies are planned to determine the precise immunologic defect, the role of socioeconomic and nutritional factors, and the natural history. Intervention studies to limit breast feeding and hence HTLV-I transmission are also planned.
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Affiliation(s)
- L La Grenade
- Department of Medicine, University of the West Indies, Mona, Jamaica
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