Paraparesia espástica tropical autóctona en la Comunidad de Madrid. Experiencia en el cribado del virus linfotrópico de células T humanas tipo I

espanolRecientemente hemos documentado un caso de paraparesia espastica tropical por HTLV-I en un paciente de nacionalidad espanola. Este retrovirus infrecuente en Europa rara vez produce sintomatologia, pero cuando lo hace supone un grave problema sanitario. Aqui presentamos dicho caso y discutimos situaciones clinicas que justifiquen su deteccion. Se analizaron las peticiones de cribado de HTLV que recibimos durante 2014-2015 (n=123). El algoritmo diagnostico fue: 1) Enzimoinmunoanalisis, 2) Hibridacion reversa y 3) PCR de ADN proviral. Los resultados mostraron diversas situaciones de cribado de HTLV, destacando el estudio de paraparesia (22%). Se detectaron 7 casos de infeccion por HTLV-I: 5 pacientes de zona endemica, un paciente VIH+ y por ultimo el caso de paraparesia mencionado. La vigilancia de HTLV-I en regiones no endemicas supone un reto sanitario al no estar bien establecido su balance coste-beneficio. Este caso apoya la inclusion de HTLV-I dentro del diagnostico diferencial de paraparesia espastica de evolucion insidiosa. EnglishWe have recently documented a case of tropical spastic paraparesis by HTLV-I in a Spanish patient. HTLV-I infection is rare in Europe, and hardly ever is accompanied by symptoms, but if it does it could trigger a major health issue. This case is presented here, as well as a discussion on the situations in which HTLV-I detection is justified. An analysis was made of the HTLV diagnostic requests at our centre during 2014-2015 (n=123). The diagnostic algorithm was: 1) Enzyme immunoassay, 2) Reverse hybridization, and 3) Proviral DNA detection by PCR. The results showed several situations of HTLV screening, emphasising those related to paraparesis (22%). Seven cases of HTLV-I infection were found: five in patients from endemic regions, one in an HIV-infected patient, and the case of TSP mentioned above. HTLV-I surveillance in non-endemic regions is a challenging issue, as the cost-benefit ratio is not well-established. This case report emphasises the importance of including HTLV within the differential diagnosis of insidious spastic paraparesis