HTLV Type 1-Associated Infective Dermatitis in South Africa
The human T-cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (IDH) was first reported in Carribean children; the incidence and pathogenesis are unknown. Somewhat reminescent of seborhoeic dermatitis, the clinical presentation of IDH is that of severe exudative dermatitis with crusting of the scalp, neck, axillae, groin, external ear, and retro-auricular areas; watery nasal discharge, and/or crusting of the anterior nares, from about 2 years of age. We identified fewer than 30 publications which report less than 300 cases of IDH worldwide; reviewed in The largest series reported 50 patients from Jamaica. There has only been one report of five African cases with IDH from Senegal. IDH has been linked with the development of adult T cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/paraparesis (HAM/TSP). We aimed to examine the clinical and aetiological characteristics of IDH in a cohort of South African children.
Following ethical approval by the Biomedical Research Ethics Committee, University of KwaZulu Natal, we enrolled sixty individuals with suspected IDH, screened using the established criteria, Table 1, amongst outpatients attending dermatology clinic at King Edward VIII Hospital, Durban KwaZulu Natal (KZN). Where possible, the parents and siblings of the HTLV-1 seropositive participants were also recruited. Written informed consent was obtained from the patients for publication of this case series and the accompanying images. A detailed dermatological examination was done. Formal ophthalmologic and neurologic examinations were conducted on patients who had symptoms and/or signs of visual and neurological abnormalities respectively. Diagnosis of HAM/TSP was made according to WHO guidelines.
Background
The human T-cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (IDH) was first reported in Carribean children; the incidence and pathogenesis are unknown. Somewhat reminescent of seborhoeic dermatitis, the clinical presentation of IDH is that of severe exudative dermatitis with crusting of the scalp, neck, axillae, groin, external ear, and retro-auricular areas; watery nasal discharge, and/or crusting of the anterior nares, from about 2 years of age. We identified fewer than 30 publications which report less than 300 cases of IDH worldwide; reviewed in The largest series reported 50 patients from Jamaica. There has only been one report of five African cases with IDH from Senegal. IDH has been linked with the development of adult T cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/paraparesis (HAM/TSP). We aimed to examine the clinical and aetiological characteristics of IDH in a cohort of South African children.
Study Subjects
Following ethical approval by the Biomedical Research Ethics Committee, University of KwaZulu Natal, we enrolled sixty individuals with suspected IDH, screened using the established criteria, Table 1, amongst outpatients attending dermatology clinic at King Edward VIII Hospital, Durban KwaZulu Natal (KZN). Where possible, the parents and siblings of the HTLV-1 seropositive participants were also recruited. Written informed consent was obtained from the patients for publication of this case series and the accompanying images. A detailed dermatological examination was done. Formal ophthalmologic and neurologic examinations were conducted on patients who had symptoms and/or signs of visual and neurological abnormalities respectively. Diagnosis of HAM/TSP was made according to WHO guidelines.
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