PubMed · 7829019
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R G Shidrawi, D Westaby. 1994. Strongyloidiasis.. https://doi.org/10.1136/gut.35.12.1772
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TSP/HAM, a chronic spastic paraparesis or paraplegia with sphincter disturbances and minimal sensory loss, is characterized pathologically by a meningo-myelitis of the lower thoracic cord with axonal degeneration and demyelinisation of the lateral and anterior spinal tracts. High titer specific anti HTLV-I antibody is present in the serum and in the cerebrospinal fluid with specific intrathecal IgG synthesis, elevated IgG index and intra blood-brain barrier IgG synthesis. Most TSP/HAM patients also exhibit IgG oligoclonal bands in the CSF (also sometimes in the serum), some of those being HTLV-I specific, directed against p24 or against various antigens of the disrupted virus. HTLV-I specific cytotoxic T lymphocytes (CTL), mainly CD8+HLA class I restricted, and recognizing several HTLV-I epitopes especially of the tax, the rex and env proteins are present at high levels in the blood and CSF of TSP/HAM patients. These findings of high CTL activity have led some authors to suggest that these specific CD8 cells may play a major role in TSP/HAM pathogenesis by destruction of HTLV-I infected cells within the central nervous system. Such an hypothesis remains a matter of controversy since some groups have shown that such CTL (both CD8+ or CD4+) are also present in asymptomatic HTLV-I carriers. Recent data have confirmed the high proviral load in PBMC of TSP/ HAM patients (as compared to asymptomatic HTLV-I carriers); however viral expression is very low. There is also recent evidence that more than one copy of HTLV-I proviral DNA may be present in an individual PBMC. One major unanswered question is whether HTLV-I can infect central nervous system cells (neurons, or astrocytes) or if the only HTLV-I infected cells present in the CNS are the infiltrating CD4+ cells. There are published reports supporting both hypotheses. Futhermore, no specific HTLV-I sequences have been related to a given disease outcome, whereas several molecular studies have clearly demonstrated that nucleotide changes in some parts of the HTLV-I genome are correlated with the geographical origin of the patients.
To estimate the current trend in prevalence of endogenous uveitis and HTLV-I-associated uveitis (HAU) in a local area, we sent questionnaires to all ophthalmologic clinics in Kagoshima Prefecture, southern Japan, which has a population of 1.8 million, with reference to uveitis patients seen during May-July 1993 and May-June 1994. Answers to the questionnaires were obtained from about half of the ophthalmologists in each survey session. The proportion of uveitis cases was on the average 0.4% of outpatients, and the prevalence of uveitis was estimated to be 40.4 x 10(-5). The major uveitis entity consisted of toxoplasmosis (7.8%), Vogt-Koyanagi-Harada disease (5.0%), Behçet's disease (4.1%), sarcoidosis (3.4%), and 71.3% of unclassified cases. An additional study for the infection with HTLV-I revealed that the seropositivity for anti-HTLV-I antibodies was 11 (17.5%) of 63 patients with distinct uveitis entities and 38 (30.4%) of 125 patients with etiologically undefined uveitis, indicating no significant difference in HTLV-I infection between the two groups. The prevalence of HAU was estimated to be 8.8 x 10(-5).