CLINICAL, PATHOLOGICAL, AND IMMUNOLOGICAL FEATURES OF HUMAN T-LYMPHOTROPHIC VIRUS TYPE I-ASSOCIATED INFECTIVE DERMATITIS IN CHILDREN

Objectives: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotrophic virus type I(HTLV-I), Design: A case series of patient s with ID were compared with patients with atopic dermatitis (AD), whi ch is an important disease in the differential diagnosis of ID. Settin g: Patients were recruited from dermatology and pediatric clinics at t he University Hospital of the West Indies and the Bustamante Children' s Hospital, Kingston, Jamaica. Main Outcome Measures: Clinical and lab oratory features of patients with AD were compared with those of patie nts with ID. Patients: Consecutive patients older than 1 1/2 years dia gnosed as having ID (n=50) and AD (n=35) were enrolled based on clinic al findings. Results: The mean ages of patients with ID and AD were 6. 9 and 7.8 years, respectively. Histologically, both diseases were pred ominantly chronic dermatitis with propensity for skin colonization wit h Staphylococcus aureus and beta-hemolytic streptococci; however, the distribution of sites of skin involvement differed. Infection with HTL V-I was the most distinguishing feature among patients with ID, with s eropositive results in 100%; only 5 (14%) of the 35 patients with AD h ad results seropositive for HTLV-I. Infective dermatitis was further c haracterized by dermatopathic lymphadenitis in 16 (67%) of 24 patients with Palpable nodes. Anemia, lymphocytosis, and low albumin and eleva ted serum globulin levels were more prevalent among patients with ID. Significant elevations of IgA, IgD, and IgG levels were observed among patients with ID compared with those with AD. However, both patients with AD and those with ID had levels of IgD and IgE elevated above the normal range. T-cell subsets among patients with ID revealed T-cell a ctivation with a high percentage of HLA-DR antigen positivity, elevate d CD4 (2.4 x 10(9)/L) and CD8 (1.4 x 10(9)/L) cell counts, with an inc reased CD4/CD8 ratio of 1:73. Conclusion: Infective dermatitis is a di stinct clinical entity associated with HTLV-I, which plays a role in t he pathogenesis and immune perturbations observed.