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NEUROLOGY 1991;41:1355
© 1991 American Academy of Neurology

HTLV-I—associated myelopathy/tropical spastic paraparesis in the United States

R. S. Janssen, MD, J. E. Kaplan, MD, R. F. Khabbaz, MD, R. Hammond, MD, R. Lechtenberg, MD, M. Lairmore, DVM, PhD, M. A. Chiasson, DrPH, A. Punsalang, PhD, B. Roberts, BS, R. R. McKendall, MD, M. Rosenblum, MD, B. Brew, MB, FRACP, J. Farraye, MD, D. J. Howley, MD, E. Feraru, MD, S. Sparr, MD, J. Vecchio, MD, M. Silverman, MD, M. McHarg, MD, B. Gorin, MD, D. R. Rugg, MD, S. Grenell, MD, B. Trimble, MD, K. Bruining, MD, S. Guha, MD, P. Amaraneni, MD and R. W. Price, MD

Retrovirus Diseases Branch (Drs. Janssen, Kaplan, Khabbaz, and Lairmore, and Ms. Roberts), Division of Viral and Rickettsial Diseases, Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, GA; Emory University School of Medicine (Dr. Hammond), Atlanta, GA; Long Island College Hospital (Dr. Lechtenberg), Brooklyn, NY; New York City Health Department (Drs. Chiasson and Punsalang), New York, NY; University of Texas Medical Branch (Dr. McKendall), Galveston, TX; Memorial Hospital for Cancer and Allied Diseases (Dr. Rosenblum), New York, NY; St. Vincent's Hospital (Dr. Brew), Sydney, Australia; City Hospital Center (Dr. Farraye), Elmhurst, NY; Hilton Head, SC (Dr. Howley); Keith Medical Group (Dr. Feraru), Los Angeles, CA; Montefiore Medical Center (Drs. Sparr, Rugg, Grenell, Bruining, and Guha), Bronx, NY; Hospital of San Raphael (Dr. Vecchio), New Haven, CT; Presbyterian Medical Center (Dr. Silverman), Philadelphia, PA; Bronx Municipal Hospital (Dr. McHarg), Bronx, NY; Bronx Cross County Medical Group (Dr. Gorin), Bronx, NY; Alaska Native Medical Center (Dr. Trimble), Anchorage, AK; Q and R Clinic (Dr. Amaraneni), Bismarck, ND; and University of Minnesota, School of Medicine (Dr. Price), Minneapolis, MN.

HTLV-I—associated myelopathy/tropical spastic paraparesis (HAM/TSP) is endemic in the Caribbean basin and Japan. Because of the close proximity of the United States to the Caribbean and the presence of HTLV-I-seropositive persons in the United States, we sought reports of patients who were HTLV-I-seropositive and had a slowly progressive myelopathy. Over a 2-year period, there were 25 patients reported, 19 of whom were black and 12 of whom had been born in the United States. All patients except two had become symptomatic while living in the United States. Six patients had no apparent risk factor for acquiring HTLV-I. These data demonstrate that HAM/TSP is occurring in the United States and that the diagnosis of HAM/TSP should be considered in patients with a slowly progressive myelopathy regardless of risk factors for acquiring HTLV-I.

Address correspondence and reprint requests to Dr. Robert S. Janssen, Division of HIV/AIDS (E-46), Centers for Disease Control, 1600 Clifton Rd, Atlanta, GA 30333.

Received December 4, 1990. Accepted for publication in final form February 5, 1991.




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