Pulmonary involvement in HTLV-I patients has been identified by several authors in Africa, Japan and Brazil. The objective of this controlled study is to establish an association between HAM and lymphocytosis in the bronchoalveolar fluid (BAL). Thirty-five adult patients with non-traumatic and non-tumoral myelopathy filled out a detailed historical survey and underwent a neurological examination, a thoracic radiological evaluation and a CSF examination. Of the patients in this sample, 22 were diagnosed with HTLV-I associated myelopathy and 13 had myelopathies with other etiologies. Lymphocytosis in the BAL fluid was detected in 18 (82%) of the HAM patients and in 2 (15%) of non-HAM patients. We concluded that the lung represents an important organ in the pathogenesis of HAM.

Cytomegalovirus (CMV) causes several neurological diseases in the late stages of AIDS, but their ante-mortem diagnosis is problematic.Clinical criteria (defining a presumptive diagnosis) and polymerase chain reaction $4 (PCR) assay from cerebrospinal fluid (CSF) were blindly used to predict the involvement of CMV in neurological disorders of 164 consecutive AIDS patients undergoing a lumbar puncture.During the follow-up, a definite diagnosis based on viral culture of CSF, clinical outcome and/or CNS histology was allowed in 88 patients, 27 (16 %) of whom had a proven CMV related neurological disease.The concordance between the presumptive and definite diagnosis was of 60 %, inducing a moderate agreement kappa index of 0.40.In contrast, the sensitivity and specificity of PCR were respectively of 89 and 94 %, with a positive and negative predictive values of 86 and 95 %.Cytomegalovirus related neurological diseases appeared thus as a frequent complication of AIDS, and detection of viral DNA in CSF by means of PCR seems a reliable tool for their diagnosis, allowing its use for therapeutic decisions 20 99mTC-HMPAO LEUCOCYTE SCINTIGRAPHY IN DIAGNOSIS

Paraparesia espástica progressiva associada a HTLV-1 constitui-se em uma patologia com características endêmicas em várias regiões do Brasil. Em Salvador, 102 pacientes com mielopatias de diversas etiologias foram triados para HTLV-I/II com ELISA e Western blot em quatro hospitais gerais que assistem a população de baixa renda. Foram encontrados 36 pacientes com mielopatia associada a HTLV-I/II, o que está de acordo com a elevada prevalência dessa patologia em Salvador. Todos os pacientes com infecção pelo HTLV-I/ II apresentavam paraparesia espástica progressiva, bexiga neurogênica associada, a graus variáveis de comprometimento sensitivo superficial e/ou profundo e síndrome do neurônio motor inferior. O exame de LCR mostrou pleocitose linfocitária com aumento moderado de gama-globulinas e a ressonância magnética mostrou graus variáveis de lesões periventriculares e subcorticais associadas ou não a atrofia da medula espinal torácica. O exame neurológico e os dados de ressonância magnética sugerem que os pacientes com comprometimento neurológico por HTLV-I podem estar acometidos por graus variáveis de leucoencefalomieloneuropatia.

A descoberta da associação entre paraparesia espástica tropical e o protovírus T-linfotrópico humano determinou a verificação da existência de uma endemia infecciosa com comprometimento neurológico caracterizado por acometimento de todo o sistema nervoso e por envolvimento de múltiplos órgãos. A característica sistêmica dessa patologia manifesta-se por lesões de órgãos distintos como pulmão, pele e fígado, entre outros. Provavelmente, o quadro clínico pleomórfico dessa doença se deve a co-fatores ainda não esclarecidos.

HTLV-I associated myelopathy has been described as a systemic disease characterized by manifestations in several organs outside the nervous system. We report inflammatory pulmonary involvement in patients with diagnosis of HAM.