DERMATOLOGIC LESIONS IN ASYMPTOMATIC BLOOD DONORS SEROPOSITIVE FOR HUMAN T CELL LYMPHOTROPIC VIRUS TYPE-1 DENISE UTSCH GONÇALVES, ANTÔNIO CARLOS MARTINS GUEDES, ANNA BÁRBARA DE FREITAS CARNEIRO PROIETTI, MARINA LOBATO MARTINS, FERNANDO AUGUSTO PROIETTI, JOSÉ ROBERTO LAMBERTUCCI, AND THE INTERDISCIPLINARY HTLV-1/2 RESEARCH GROUP Departments of Internal Medicine and Basic Sciences Institute, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Minas Gerais State Center of Hematology and Hemotherapy, Belo Horizonte, Minas Gerais, Brazil Abstract. Dermatologic manifestations are quite common in patients with adult T cell leukemia/lymphoma and myelopathy/tropical spastic paraparesis associated with infection with human T cell lymphotropic virus type-1 (HTLV- 1). In this study, we evaluated the dermatologic lesions of eligible blood donors in the state of Minas Gerais in Brazil who were seropositive but asymptomatic for infection with HTLV-1. The study population was composed of 128 HTLV-1-seropositive individuals and 108 seronegative controls. All individuals underwent a dermatologic evaluation. Biopsy specimens were obtained from abnormal and normal skin samples of seropositive individuals in an attempt to detect HTLV-1 in tissue samples by a polymerase chain reaction. Dermatologic alterations were observed more fre- quently in the seropositive group (adjusted odds ratio [OR]  8.77, 95% confidence interval [CI]  4.11-18.71). The most common skin diseases were dermatophytoses (adjusted OR  3.32, 95% CI  1.50-7.35), seborrheic dermatitis (OR  3.53, 95% CI  0.67-24.66), and acquired ichthyosis (P  0.001). Virus was detected more frequently in abnormal skin samples. Dermatologic lesions probably related to HTLV-1 infection were diagnosed in eligible blood donors who were infected with this virus, who were previously considered to be asymptomatic carriers of HTLV-1. INTRODUCTION The human T cell lymphotropic virus type-1 (HTLV-1) is associated with adult T cell leukemia/lymphoma (ATL) and other disorders, including an inflammatory demyelinating chronic progressive myelopathy known as HTLV-1-asso- ciated myelopathy/tropical spastic paraparesis (HAM/ TSP). 1,2 Dermatologic manifestations are quite common in both diseases. 3,4 Patients with HAM/TSP may have skin manifestations such as xerosis and erythema. 3 Infective der- matitis of childhood, a severe, exudative eczema involving infection with Staphylococcus aureus or -hemolytic Strepto- coccus, is the only well-described outcome of childhood HTLV-1 infection. Anecdotal data suggest that it may be a risk factor for development of ATL in Jamaica. 4 Infection with HTLV-1 is endemic in southern Japan, 5 the Caribbean region, and intertropical Africa. The prevalence of this virus in Brazil has been estimated to be approximately 0.41%, ranging from 0.1% in the blood donor population in the state of Minas Gerais (southeastern region) to 1.4% in the state of Bahia in the northeastern part of the country. In this study, we investigated the association of HTLV-1 with skin diseases among blood donors and whether HTLV-1 is found more often in skin lesions of infected persons com- pared with their normal skin. MATERIALS AND METHODS Patients and controls. Blood donors at the Minas Gerais Blood Center in Belo Horizonte, Brazil who were seroposi- tive for infection with HTLV-1 were selected for participation in the study. After filling out a routine pre-donation ques- tionnaire and undergoing and passing a clinical examination, individuals considered eligible for blood donation (those be- tween 18 and 60 years of age who were in good general health, had no risk behavior for retrovirus infections [e.g., illegal in- jectable drug use, unsafe sex, and tattooing], and who had not received blood [or blood product] transfusions) were tested for blood-transmitted infections, namely human immunode- ficiency viruses-1/2 (HIV-1/2), hepatitis B virus (HBV), HCV, Trypanosoma cruzi, and Treponema pallidum. In Brazil, all blood donors are volunteers and any reimbursement for blood donation is illegal. The seronegative control group was randomly selected from qualified blood donors during the same period. One of every three individuals on the list of clinically and serologically approved blood donors was chosen to participate in the study. Two-hundred thirty-six subjects, 128 who were seropositive for HTLV-1 and 108 who were seronegative for HTLV-1, were enrolled in the study between March 1997 and April 1999. The study was reviewed and approved by the ethics committee of the Faculty of Medicine of the Federal University of Minas Gerais (Belo Horizonte, Brazil). Informed consent was obtained from each participant in the study. Dermatologic evaluation. Skin examinations were per- formed by a dermatologist from the Faculty of Medicine of the Federal University of Minas Gerais. Dermatologic diagnoses were defined by clinical and histologic criteria for each disease; staining with potassium hydroxide was used in cases of cutaneous mycosis. Biopsies of normal skin midway along the left interscapulo-vertebral area were also per- formed. The specimens obtained were examined by light mi- croscopy using routine stains, and the presence of HTLV-1 was investigated by a nested polymerase chain reaction (PCR). One dermatopathologist was responsible for the his- tologic analysis. Examiners did not know the serologic status of the individuals/specimens during clinical and histologic evaluations. SeropositivityforHTLV-1. Seropositivity for infection with HTLV-1 was defined as repeated reactivity in blood samples tested by an enzyme-linked immunosorbent assay (Abbott Laboratories, Abbott Park, IL). This was confirmed by West- ern blotting (HTLV-1/2; Cambridge Biotech, Cambridge, MA) and an HTLV-1 nested PCR with peripheral blood mononuclear cells. Nested polymerase chain reaction (PCR). The same PCR procedure was used for testing of blood and skin samples. Am. J. Trop. Med. Hyg., 68(5), 2003, pp. 562–565 Copyright © 2003 by The American Society of Tropical Medicine and Hygiene 562