Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the Literature
HTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a progressive non-remitting and incapacitating disease more frequently seen in women and with a patchy worldwide distribution. HAM/TSP develops in a small percentage of HTLV-1-infected individuals during their lifetime and etiolo...
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2024-08-01
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| author | Frederique A. Jacquerioz Mauricio La Rosa Elsa González-Lagos Carolina Alvarez Martin Tipismana Karen Luhmann Eduardo Gotuzzo |
| author_facet | Frederique A. Jacquerioz Mauricio La Rosa Elsa González-Lagos Carolina Alvarez Martin Tipismana Karen Luhmann Eduardo Gotuzzo |
| author_sort | Frederique A. Jacquerioz |
| collection | DOAJ |
| description | HTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a progressive non-remitting and incapacitating disease more frequently seen in women and with a patchy worldwide distribution. HAM/TSP develops in a small percentage of HTLV-1-infected individuals during their lifetime and etiologic factors for disease progression are still unclear. This study aims to describe the first case series of the progression of HAM/TSP in relation to pregnancy. Between January and March of 2012, we reviewed medical charts of women with HAM/TSP currently enrolled in the HTLV-1 cohort at the institute of tropical medicine of Cayetano Heredia University. Inclusion criteria included having a diagnosis of HAM/TSP according to the WHO guidelines and self-reported initial symptoms of HAM/TSP during pregnancy or within six months of delivery. Fifteen women reported having had symptoms compatible with HAM/TSP within four months of delivery. Among them, ten women had no symptoms before pregnancy and reported gait impairment after delivery. Five women with mild gait impairment before pregnancy noticed a worsening of their symptoms after delivery. Symptoms worsened after successive pregnancies. Recent studies have shown that HTLV-1 infection induces a strong T cell-mediated response and that the quality of this response plays a role in HAM/TSP pathogenesis. The relative immunosuppression during pregnancy, including blunting of the T-cell response, might allowed in certain women enhanced replication of HTLV-1 and disease progression in the postpartum. This is the first study looking specifically at HAM/TSP and pregnancy and the number of cases is remarkable. Further prospective studies of HTLV-1-infected women assessing immune markers during pregnancy are warranted. Breastfeeding was the main route of transmission. Strategies to prevent vertical transmission need to be evaluated in HTLV-1 endemic countries of Latin America. |
| format | Article |
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| institution | OA Journals |
| issn | 2076-0817 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | MDPI AG |
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| series | Pathogens |
| spelling | doaj-art-7d4cf843f4354e468d3ca8bdec7851382025-08-20T01:55:45ZengMDPI AGPathogens2076-08172024-08-0113973110.3390/pathogens13090731Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the LiteratureFrederique A. Jacquerioz0Mauricio La Rosa1Elsa González-Lagos2Carolina Alvarez3Martin Tipismana4Karen Luhmann5Eduardo Gotuzzo6Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USADepartment of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA 19107, USAInstitute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstitute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstitute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstitute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstitute of Tropical Medicine Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 15102, PeruHTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a progressive non-remitting and incapacitating disease more frequently seen in women and with a patchy worldwide distribution. HAM/TSP develops in a small percentage of HTLV-1-infected individuals during their lifetime and etiologic factors for disease progression are still unclear. This study aims to describe the first case series of the progression of HAM/TSP in relation to pregnancy. Between January and March of 2012, we reviewed medical charts of women with HAM/TSP currently enrolled in the HTLV-1 cohort at the institute of tropical medicine of Cayetano Heredia University. Inclusion criteria included having a diagnosis of HAM/TSP according to the WHO guidelines and self-reported initial symptoms of HAM/TSP during pregnancy or within six months of delivery. Fifteen women reported having had symptoms compatible with HAM/TSP within four months of delivery. Among them, ten women had no symptoms before pregnancy and reported gait impairment after delivery. Five women with mild gait impairment before pregnancy noticed a worsening of their symptoms after delivery. Symptoms worsened after successive pregnancies. Recent studies have shown that HTLV-1 infection induces a strong T cell-mediated response and that the quality of this response plays a role in HAM/TSP pathogenesis. The relative immunosuppression during pregnancy, including blunting of the T-cell response, might allowed in certain women enhanced replication of HTLV-1 and disease progression in the postpartum. This is the first study looking specifically at HAM/TSP and pregnancy and the number of cases is remarkable. Further prospective studies of HTLV-1-infected women assessing immune markers during pregnancy are warranted. Breastfeeding was the main route of transmission. Strategies to prevent vertical transmission need to be evaluated in HTLV-1 endemic countries of Latin America.https://www.mdpi.com/2076-0817/13/9/731human T lymphotropic virus 1HTLV-1pregnancypostpartumHTLV-1 associated myelopathy/tropical spastic paraparesis |
| spellingShingle | Frederique A. Jacquerioz Mauricio La Rosa Elsa González-Lagos Carolina Alvarez Martin Tipismana Karen Luhmann Eduardo Gotuzzo Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the Literature Pathogens human T lymphotropic virus 1 HTLV-1 pregnancy postpartum HTLV-1 associated myelopathy/tropical spastic paraparesis |
| title | Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the Literature |
| title_full | Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the Literature |
| title_fullStr | Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the Literature |
| title_full_unstemmed | Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the Literature |
| title_short | Progression of HTLV-1 Associated Myelopathy/Tropical Spastic Paraparesis after Pregnancy: A Case Series and Review of the Literature |
| title_sort | progression of htlv 1 associated myelopathy tropical spastic paraparesis after pregnancy a case series and review of the literature |
| topic | human T lymphotropic virus 1 HTLV-1 pregnancy postpartum HTLV-1 associated myelopathy/tropical spastic paraparesis |
| url | https://www.mdpi.com/2076-0817/13/9/731 |
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