Human T-lymphotrophic virus type 1–associated infective dermatitis: A comprehensive review
2010; Elsevier BV; Volume: 64; Issue: 1 Linguagem: Inglês
10.1016/j.jaad.2009.10.021
ISSN1097-6787
AutoresRobert Lee, Robert A. Schwartz,
Tópico(s)Animal Disease Management and Epidemiology
ResumoInfective dermatitis (ID) is a chronic, relapsing dermatitis associated with human T-lymphotrophic virus (HTLV)-1 which was initially described in Jamaican children. Although most cases have been reported in Jamaica, ID may be seen in other HTLV-1 endemic areas, such as Brazil, Japan, sub-Saharan Africa, and Trinidad and Tobago. Since HTLV-1 infection has been implicated in the development of adult T-cell leukemia/lymphoma, an aggressive hematologic malignancy, and HTLV-1-associated myelopathy/tropical spastic paraparesis, a neurodegenerative disease, ID may serve as an early clinical marker for either condition. Although HTLV-1-associated infective dermatitis is considered by most to be rare, it has been increasingly diagnosed over the past 20 years; some suggest ID may be underdiagnosed. One should maintain suspicion of HTLV-1 infection among individuals in or from endemic areas, recognizing the clinical features and prognostic implications of infectious dermatitis. Infective dermatitis (ID) is a chronic, relapsing dermatitis associated with human T-lymphotrophic virus (HTLV)-1 which was initially described in Jamaican children. Although most cases have been reported in Jamaica, ID may be seen in other HTLV-1 endemic areas, such as Brazil, Japan, sub-Saharan Africa, and Trinidad and Tobago. Since HTLV-1 infection has been implicated in the development of adult T-cell leukemia/lymphoma, an aggressive hematologic malignancy, and HTLV-1-associated myelopathy/tropical spastic paraparesis, a neurodegenerative disease, ID may serve as an early clinical marker for either condition. Although HTLV-1-associated infective dermatitis is considered by most to be rare, it has been increasingly diagnosed over the past 20 years; some suggest ID may be underdiagnosed. One should maintain suspicion of HTLV-1 infection among individuals in or from endemic areas, recognizing the clinical features and prognostic implications of infectious dermatitis. Capsule Summary•Human T-lymphotrophic virus (HTLV)-1-associated infective dermatitis is a severe, chronic, relapsing dermatitis of childhood that significantly affects quality of life.•Infective dermatitis may serve as an early clinical marker for HTLV-1 infection and an indicator of increased risk for developing other HTLV-1-associated diseases.•Most cases of HTLV-1-associated infective dermatitis have been documented in Jamaica. However, many new cases have been recently reported in other HTLV-1 endemic regions such as Senegal and Brazil.Infective dermatitis (ID) is a severe, chronic, relapsing dermatitis associated with human T-lymphotrophic virus (HTLV)-1.1La Grenade L. Schwartz R.A. Janniger C.K. Childhood dermatitis in the tropics: with special emphasis on infective dermatitis, a marker for infection with human T-cell leukemia virus-I.Cutis. 1996; 58: 115-118PubMed Google Scholar It was initially described as a distinct clinical entity in Jamaican children by Robert Douglass Sweet2Sweet R.D. A pattern of eczema in Jamaica.Br J Dermatol. 1966; 78: 93-100Crossref PubMed Scopus (55) Google Scholar in 1966. The following year, Walshe3Walshe M.M. Infective dermatitis in Jamaican children.Br J Dermatol. 1967; 79: 229-236Crossref PubMed Scopus (31) Google Scholar identified additional cases with a similar pattern of dermatitis. In 1980, Poiesz et al4Poiesz B.J. Ruscetti F.W. Gazdar A.F. Bunn P.A. Minna J.D. Gallo R.C. Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma.Proc Natl Acad Sci U S A. 1980; 77: 7415-7419Crossref PubMed Scopus (4224) Google Scholar isolated and identified HTLV-1, the first retrovirus to be associated with human disease. It was originally associated with adult T-cell leukemia/lymphoma (ATL),4Poiesz B.J. Ruscetti F.W. Gazdar A.F. Bunn P.A. Minna J.D. Gallo R.C. Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma.Proc Natl Acad Sci U S A. 1980; 77: 7415-7419Crossref PubMed Scopus (4224) Google Scholar, 5Yoshida M. Seiki M. Yamaguchi K. Takatsuki K. Monoclonal integration of human T-cell leukemia provirus in all primary tumors of adult T-cell leukemia suggests causative role of human T-cell leukemia virus in the disease.Proc Natl Acad Sci U S A. 1984; 81: 2534-2537Crossref PubMed Scopus (787) Google Scholar an aggressive hematologic malignancy, and HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP),6Gessain A. Barin F. Vernant J.C. Gout O. Maurs L. Calender A. et al.Antibodies to human T-lymphotrophic virus type-I in patients with tropical spastic paraparesis.Lancet. 1985; 2: 407-410Abstract PubMed Scopus (2542) Google Scholar, 7Osame M. Usuku K. Izumo S. Ijichi N. Amitani H. Igata A. et al.HTLV-I associated myelopathy, a new clinical entity.Lancet. 1986; 1: 1031-1032Abstract PubMed Scopus (2029) Google Scholar, 8Rodgers-Johnson P. Gajdusek D.C. Morgan O.S. Zaninovic V. Sarin P.S. Graham D.S. HTLV-I and HTLV-III antibodies and tropical spastic paraparesis.Lancet. 1985; 2: 1247-1248Abstract PubMed Scopus (240) Google Scholar a degenerative neurologic disease. It was not until 1990 that La Grenade et al9La Grenade L. Hanchard B. Fletcher V. Cranston B. Blattner W. Infective dermatitis of Jamaican children: a marker for HTLV-I infection.Lancet. 1990; 336: 1345-1347Abstract PubMed Scopus (382) Google Scholar reported a link between HTLV-1 and ID in a pilot survey which was subsequently confirmed in a case-control study 2 years later.10La Grenade L. Fletcher V. Carberry C. Hanchard B. Cranston B. Williams N.P. et al.Infective dermatitis of Jamaican children 1966-1991.West Indian Med J. 1992; 41: 33Google Scholar HTLV-1 has also been linked with several other disorders, including uveitis,11Mochizuki M. Watanabe T. Yamaguchi K. Tajima K. Yoshimura K. Nakashima S. et al.Uveitis associated with human T lymphotrophic virus type I: seroepidemiologic, clinical, and virologic studies.J Infect Dis. 1992; 166: 943-944Crossref PubMed Scopus (99) Google Scholar arthropathy,12Nishioka K. Maruyama I. Sato K. Kitajima I. Nakajima Y. Osame M. Chronic inflammatory arthropathy associated with HTLV-I.Lancet. 1989; 1: 441Abstract PubMed Scopus (361) Google Scholar polymyositis,13Morgan O.S. Rodgers-Johnson P. Mora C. Char G. HTLV-1 and polymyositis in Jamaica.Lancet. 1989; 2: 1184-1187Abstract PubMed Scopus (301) Google Scholar thyroiditis,14Kawai H. Inui T. Kashiwagi S. Tsuchihashi T. Masuda K. Kondo A. et al.HTLV-I infection in patients with autoimmune thyroiditis (Hashimoto's thyroiditis).J Med Virol. 1992; 38: 138-141Crossref PubMed Scopus (55) Google Scholar and Sjögren syndrome.15Terada K. Katamine S. Eguchi K. Moriuchi R. Kita M. Shimada H. et al.Prevalence of serum and salivary antibodies to HTLV-1 in Sjogren's syndrome.Lancet. 1994; 344: 1116-1119Abstract PubMed Scopus (212) Google Scholar ID may be the initial manifestation of HTLV-1 infection. The subsequent development of ATL and HAM/TSP in patients with this condition has been well documented.16Tsukasaki K. Yamada Y. Ikeda S. Tomonaga M. Infective dermatitis among patients with ATL in Japan.Int J Cancer. 1994; 57: 293Crossref PubMed Scopus (38) Google Scholar, 17La Grenade L. Morgan C. Carberry C. Hanchard B. Fletcher V. Gray R. et al.Tropical spastic paraparesis occurring in HTLV-1 associated infective dermatitis: report of two cases.West Indian Med J. 1995; 44: 34-35PubMed Google Scholar, 18Hanchard B. La Grenade L. Carberry C. Fletcher V. Williams E. Cranston B. et al.Childhood infective dermatitis evolving into adult T-cell leukemia after 17 years.Lancet. 1991; 338: 1593-1594Abstract PubMed Scopus (73) Google Scholar, 19La Grenade L. Sonoda S. Miller W. Pate E. Rodgers-Johnson P. Hanchard B. et al.HLA DRB1∗DQB1∗ haplotype in HTLV-I-associated familial infective dermatitis may predict development of HTLV-I-associated myelopathy/tropical spastic paraparesis.Am J Med Genet. 1996; 61: 37-41Crossref PubMed Scopus (31) Google Scholar Therefore, it may serve as an early clinical marker for HTLV-1 infection and an indicator of increased risk for developing other HTLV-1-associated diseases. •Human T-lymphotrophic virus (HTLV)-1-associated infective dermatitis is a severe, chronic, relapsing dermatitis of childhood that significantly affects quality of life.•Infective dermatitis may serve as an early clinical marker for HTLV-1 infection and an indicator of increased risk for developing other HTLV-1-associated diseases.•Most cases of HTLV-1-associated infective dermatitis have been documented in Jamaica. However, many new cases have been recently reported in other HTLV-1 endemic regions such as Senegal and Brazil. Infective dermatitis is considered a rare disease in most parts of the world, with the exception of Jamaica. The recent emergence of multiple cases in Senegal,20Mahe A. Meertens L. Ly F. Sow P.S. Diop C.T. Samb N.D. et al.Human T-cell leukemia/lymphoma virus type 1-associated infective dermatitis in Africa: a report of five cases from Senegal.Br J Dermatol. 2004; 150: 958-965Crossref PubMed Scopus (41) Google Scholar Brazil,21Oliveira Mde F. Brites C. Ferraz N. Magalhaes P. Almeida F. Bittencourt A.L. Infective dermatitis associated with the human T cell lymphotrophic virus type I in Salvador, Bahia, Brazil.Clin Infect Dis. 2005; 40: e90-e96Crossref PubMed Scopus (52) Google Scholar and other countries suggests that this condition may be underdiagnosed and possibly overlooked. Because of its relative rarity, health care workers may be unaware of the existence of this dermatitis. The low medical standards in some HTLV-1 endemic areas and the unavailability of HTLV-1 diagnostic tests may also be contributing factors to its underdiagnosis.20Mahe A. Meertens L. Ly F. Sow P.S. Diop C.T. Samb N.D. et al.Human T-cell leukemia/lymphoma virus type 1-associated infective dermatitis in Africa: a report of five cases from Senegal.Br J Dermatol. 2004; 150: 958-965Crossref PubMed Scopus (41) Google Scholar The variable presentation of this condition, which may overlap with that of other dermatologic conditions, may lead to misdiagnosis and underreporting. As a result, the full public health impact may be greater than generally perceived. Infective dermatitis is the only well-characterized manifestation of childhood HTLV-1 infection. The average age of onset is 2 years21Oliveira Mde F. Brites C. Ferraz N. Magalhaes P. Almeida F. Bittencourt A.L. Infective dermatitis associated with the human T cell lymphotrophic virus type I in Salvador, Bahia, Brazil.Clin Infect Dis. 2005; 40: e90-e96Crossref PubMed Scopus (52) Google Scholar, 22Primo J.R. Brites C. Oliveira Mde F. Moreno-Carvalho O. Machado M. Bittencourt A.L. Infective dermatitis and human T cell lymphotrophic virus type 1-associated myelopathy/tropical spastic paraparesis in childhood and adolescence.Clin Infect Dis. 2005; 41: 535-541Crossref PubMed Scopus (67) Google Scholar, 23Manns A. Hisada M. La Grenade L. Human T-lymphotrophic virus type I infection.Lancet. 1999; 353: 1951-1958Abstract Full Text Full Text PDF PubMed Scopus (284) Google Scholar; its prevalence appears to be slightly higher among female individuals.21Oliveira Mde F. Brites C. Ferraz N. Magalhaes P. Almeida F. Bittencourt A.L. Infective dermatitis associated with the human T cell lymphotrophic virus type I in Salvador, Bahia, Brazil.Clin Infect Dis. 2005; 40: e90-e96Crossref PubMed Scopus (52) Google Scholar, 23Manns A. Hisada M. La Grenade L. Human T-lymphotrophic virus type I infection.Lancet. 1999; 353: 1951-1958Abstract Full Text Full Text PDF PubMed Scopus (284) Google Scholar, 24La Grenade L. Manns A. Fletcher V. Derm D. Carberry C. Hanchard B. et al.Clinical, pathologic, and immunologic features of human T-lymphotrophic virus type I-associated infective dermatitis in children.Arch Dermatol. 1998; 134: 439-444Crossref PubMed Scopus (113) Google Scholar It decreases in severity with age and rarely continues until adulthood, perhaps because of the development of the immune system. However, cases of adult-onset ID have been described.25Bittencourt A.L. Oliveira Mde F. Ferraz N. Vieira M.G. Muniz A. Brites C. Adult-onset infective dermatitis associated with HTLV-I: clinical and immunopathological aspects of two cases.Eur J Dermatol. 2006; 16: 62-66PubMed Google Scholar Maloney et al26Maloney E.M. Hisada M. Palmer P. Brooks K. Pate E. Wiktor S.Z. et al.Human T cell lymphotrophic virus type I-associated infective dermatitis in Jamaica: a case report of clinical and biologic correlates.Pediatr Infect Dis J. 2000; 19: 560-565Crossref PubMed Scopus (22) Google Scholar calculated the incidence rate of ID among HTLV-1-infected Jamaican children to be 552 per 105 person-years (95% confidence interval 14-3080). The probability of these children developing ID by 4 years of age was 2.0%. Incidence and prevalence data for infective dermatitis outside of Jamaica have not been published, to our knowledge. The major modes of transmission include vertical transmission,27Tsuji Y. Doi H. Yamabe T. Ishimaru T. Miyamoto T. Hino S. Prevention of mother-to-child transmission of human T-lymphotrophic virus type-I.Pediatrics. 1990; 86: 11-17PubMed Google Scholar sexual contact,28Khabbaz R.F. Darrow W.W. Hartley T.M. Witte J. Cohen J.B. French J. et al.Seroprevalence and risk factors for HTLV-I/II infection among female prostitutes in the United States.JAMA. 1990; 263: 60-64Crossref PubMed Scopus (79) Google Scholar and parenteral transmission by blood transfusion29Osame M. Janssen R. Kubota H. Nishitani H. Igata A. Nagataki S. et al.Nationwide survey of HTLV-I-associated myelopathy in Japan: association with blood transfusion.Ann Neurol. 1990; 28: 50-56Crossref PubMed Scopus (227) Google Scholar or sharing of contaminated needles.23Manns A. Hisada M. La Grenade L. Human T-lymphotrophic virus type I infection.Lancet. 1999; 353: 1951-1958Abstract Full Text Full Text PDF PubMed Scopus (284) Google Scholar The most common route is probably breast-feeding. Mother-to-child transmission occurs at a rate of 9% to 32%.30Wiktor S.Z. Pate E.J. Rosenberg P.S. Barnett M. Palmer P. Medeiros D. et al.Mother-to-child transmission of human T-cell lymphotrophic virus type I associated with prolonged breast-feeding.J Hum Virol. 1997; 1: 37-44PubMed Google Scholar The rate of vertical transmission has been shown to have a positive correlation with the duration of breast-feeding and the provirus load in breast milk.31Hirata M. Hayashi J. Noguchi A. Nakashima K. Kajiyama W. Kashiwagi S. et al.The effects of breastfeeding and presence of antibody to p40tax protein of human T cell lymphotrophic virus type-I on mother to child transmission.Int J Epidemiol. 1992; 21: 989-994Crossref PubMed Scopus (45) Google Scholar, 32Oki T. Yoshinaga M. Otsuka H. Miyata K. Sonoda S. Nagata Y. 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Malley K. et al.Human T-lymphotrophic virus type I (HTLV-I) seroprevalence in Jamaica, I: demographic determinants.Am J Epidemiol. 1991; 133: 1114-1124PubMed Google Scholar, 42Hanchard B. Gibbs W.N. Lofters W. Campbell M. Williams E. Williams N. et al.Adult T-cell leukemia/lymphoma (ATL) in Jamaica.in: Blattner W.A. Human retrovirology. Raven Press, HTLV. New York (NY)1990: 173-183Google Scholar have a seroprevalence rate as high as 10% and 6%, respectively. However, most data on the prevalence of HTLV-1 are from studies in selected population groups that may not accurately represent the general population in these regions. Most cases of ID have been documented in Jamaica, where this condition accounts for 10% of childhood dermatitis.1La Grenade L. Schwartz R.A. Janniger C.K. Childhood dermatitis in the tropics: with special emphasis on infective dermatitis, a marker for infection with human T-cell leukemia virus-I.Cutis. 1996; 58: 115-118PubMed Google Scholar, 9La Grenade L. 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Infective dermatitis associated with the human T cell lymphotrophic virus type I in Salvador, Bahia, Brazil.Clin Infect Dis. 2005; 40: e90-e96Crossref PubMed Scopus (52) Google Scholar an area with the highest prevalence of HTLV-1 infection among the general population of that country (1.76%).44Galvao-Castro B. Loures L. Rodriques L.G. Sereno A. Ferreira Junior O.C. Franco L.G. et al.Distribution of human T-lymphotrophic virus type I among blood donors: a nationwide Brazilian study.Transfusion. 1997; 37: 242-243Crossref PubMed Scopus (131) Google Scholar, 45Dourado I. Alcantara L.C. Barreto M.L. da Gloria Teixeira M. Galvao-Castro B. 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Blattner W. et al.Infective dermatitis in Trinidad and Tobago.AIDS Res Hum Retroviruses. 1994; 10: 447Google Scholar Barbados,50Rabkin C.S. Corbin D. Felton S. Barker H. Davison D. Dearden C. et al.HTLV-1 infection in Barbados: results of a 20-year followup study.AIDS Res Hum Retroviruses. 1994; 10: 475Google Scholar and Peru51Aquije M. Ballona R. Dermatitis infectiva asociada a HTLV-I en el Servicio de Dermatología del instituto de la Salud del Niño.Folia Dermatol Peruana. 2002; 13: 1-8Google Scholar (Table I). In certain areas of Japan, where HTLV-1 is highly endemic, only 3 cases of ID have been documented.16Tsukasaki K. Yamada Y. Ikeda S. Tomonaga M. Infective dermatitis among patients with ATL in Japan.Int J Cancer. 1994; 57: 293Crossref PubMed Scopus (38) Google Scholar This disparity in geographic distribution among HTLV-1 endemic areas indicates that socioeconomic and genetic factors may play a role in the pathogenesis of this disease. Studies have demonstrated that patients with ID are of lower socioeconomic status and may be malnourished.20Mahe A. Meertens L. Ly F. Sow P.S. Diop C.T. Samb N.D. et al.Human T-cell leukemia/lymphoma virus type 1-associated infective dermatitis in Africa: a report of five cases from Senegal.Br J Dermatol. 2004; 150: 958-965Crossref PubMed Scopus (41) Google Scholar, 21Oliveira Mde F. Brites C. Ferraz N. Magalhaes P. Almeida F. Bittencourt A.L. Infective dermatitis associated with the human T cell lymphotrophic virus type I in Salvador, Bahia, Brazil.Clin Infect Dis. 2005; 40: e90-e96Crossref PubMed Scopus (52) Google Scholar, 22Primo J.R. Brites C. Oliveira Mde F. Moreno-Carvalho O. Machado M. Bittencourt A.L. Infective dermatitis and human T cell lymphotrophic virus type 1-associated myelopathy/tropical spastic paraparesis in childhood and adolescence.Clin Infect Dis. 2005; 41: 535-541Crossref PubMed Scopus (67) Google Scholar, 24La Grenade L. Manns A. Fletcher V. Derm D. Carberry C. Hanchard B. et al.Clinical, pathologic, and immunologic features of human T-lymphotrophic virus type I-associated infective dermatitis in children.Arch Dermatol. 1998; 134: 439-444Crossref PubMed Scopus (113) Google Scholar Another possible explanation for this varied distribution is the different viral subtypes present in HTLV-1 endemic regions.52Seiki M. Hattori S. Yoshida M. Human adult T-cell leukemia virus: molecular cloning of the provirus DNA and the unique terminal structure.Proc Natl Acad Sci U S A. 1982; 79: 6899-6902Crossref PubMed Scopus (130) Google Scholar, 53Slattery J.P. Franchini G. Gessain A. Genomic evolution, patterns of global dissemination, and interspecies transmission of human and simian T-cell leukemia/lymphotrophic viruses.Genome Res. 1999; 9: 525-540PubMed Google Scholar, 54Gessian A. Yanagihara R. Franchini G. Garruto R.M. Jenkins C.L. Ajdukiewicz A.B. et al.Highly divergent molecular variants of human T-lymphotrophic virus type I from isolated populations in Papua New Guinea and the Solomon Islands.Proc Natl Acad Sci U S A. 1991; 88: 7694-7698Crossref PubMed Scopus (128) Google Scholar, 55Sherman M.P. Saksena N.K. Dube D.K. Yanagihara R. Poiesz B.J. Evolutionary insights on the origin of human T-cell lymphoma/leukemia virus type I (HTLV-I) derived from sequence analysis of a new HTLV-I variant from Papua New Guinea.J Virol. 1992; 66: 2556-2563PubMed Google Scholar We also suggest that it may be more likely to develop in tropical climates.Table IConfirmed cases of infective dermatitis with human T-lymphotrophic virus type 1 seropositivityStudyLocationNo. of casesAssociation with ATL or HAM/TSP∗Brackets indicate number of cases within study associated with ATL or HAM/TSP.La Grenade et al9La Grenade L. Hanchard B. Fletcher V. Cranston B. Blattner W. 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