|
Memórias do Instituto Oswaldo Cruz
Fundação Oswaldo Cruz, Fiocruz
ISSN: 1678-8060 EISSN: 1678-8060
Vol. 93, Num. 4, 1998, pp. 433-434
|
Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 93 (4), July/August 1998,
pp. 433-434
Research Note
Unusual HPV Types in Cutaneous Warts in Association with
Immunological Deficiency
Silvia MB Cavalcanti^+, Flavia CC Deus, Ledy HS Oliveira
Departamento de Microbiologia e Parasitologia, Instituto Biomedico,
Universidade Federal Fluminense, Rua Ernani Melo 101, 24210-030 Niteroi,
RJ, Brasil
^+Corresponding author. Fax: +55-21-274.6823
Received 3 December 1997; Accepted 26 March 1998
Code Number:OC98084
Sizes of Files:
Text: 5.9K
Graphics: No associated graphics files
Key words: human papillomavirus - cutaneous warts - immunodeficiency
- cancer
Research Note
There are now at least 70 known types of human papillomaviruses (HPV).
Historically they have been grouped according to the location of the
lesions, thus the terminology mucosal types (including HPV infecting the
genital and the respiratory tracts) and cutaneous types (including HPV
causing cutaneous warts and epidermodysplasia verruciformis - EDV). The
different HPV types present diverse oncogenic potential and data have
accumulated to support a role for mucosal HPV in cervical cancer. Genital
HPV 16, 18, 31, 33 and 35 represent the high risk viruses associated to
malignancy while HPV 6 and 11 have been predominantly found in benign
genital lesions. In cutaneous lesions, HPV 1 and 2 are related to common
warts while HPV 5 and 8 are associated to EDV (EM de Villiers 1994 Curr
Topics Microbiol Immunol 186: 1-12). Thus, HPV typing predicts
partially the site of the infection, the pathological features and the
clinical course of the infection.
This study was undertaken to determine the HPV types infecting cutaneous
warts of two immunodeficient patients attended at Hospital Santa Casa de
Misericordia, Rio de Janeiro, Brazil. Patients presenting multicentric
cutaneous and genital warts were biopsied. Both cases were clinically and
histologically diagnosed as typical HPV-induced verrucae. Samples were
analyzed by using non-isotopic in situ hybridization (NISH) kit from
Createch Diagnosis (Holland) to detect HPV types 1, 2, 6, 11, 16, 18, 31,
33 and 35, which is described in detail by SMB Cavalcanti et al. (1994
Mem Inst Oswaldo Cruz 89: 575-580). The kit included HPV positive
and negative tissue biopsies that were used as controls in every
experiment. Positive tissues for HPV1 (skin verrucae), HPV 6 and HPV 16
(cervical condyloma) were also used as controls.
Patient 1 was a 30 years old man, presenting one-year long verrucous
lesions extending from right hand to pubis and anal region. NISH revealed
HPV types 31, 33 and 35 in five tested biopsies (two from the right hand,
one from the pubis and two from the anal region). HPV 6 and 11 were
detected in the anal biopsies. Neither HPV 1 nor HPV two were detected.
This patient was infected by HIV and presented AIDS-related complex.
Patient 2 was a 39 years old man, presenting four-year long cutaneous warts
in hands and feet, where lesions were both dorsal and plantar. Genital
lesions were not detected. Three samples (right hand and dorsal/plantar
left foot) were analyzed by NISH. High risk HPV 16 and 18 were detected in
all the samples. HPV 6 and 11 were also demonstrated in the left foot
plantar wart. HPV 1 and 2 were not found. This patient presented T-cell
inherited cellular immunodeficiency characterized by a partial suppression
of these cells, revealed by flow cytometry.
Immunological restriction in healthy patients seems to represent an
important condition to the maintenance of specific HPV types in different
body sites and to the spontaneous regression of HPV-induced lesions. The
appearance of HPV types usually associated to genital infection and cancer
in cutaneous warts may reflect the immunological failure of the body
defense system, leading to persistent lesions. Genital HPV types have only
exceptionally been reported in extragenital locations: invasive carcinoma
of the fingers (RL Moy et al. 1989 JAMA 261: 2669-2673), Bowen's
disease of the foot (MS Stone et al. 1987 Arch Dermatol 123:
1517-1520) and Bowenoid Papulosis of the face (JJ Grob et al. 1991
Genitourin Med 67: 18-20).
Since an epidemiological study was not performed, the source of the
infection was not determined. The presence of associated genital lesions in
patient 1 suggests sexual transmission and spread but for patient 2 the
absence of genital lesions makes this possibility unlikely. The risk of
malignant progression of the lesions detected in both patients can not be
excluded since oncogenic HPV types have been detected. Besides, the
immunodeficiency condition related may cooperate to neoplastic
transformation of the skin. As described by GYF Ho et al. (1994 Int J
Cancer 56: 788-792), the depression of cell-mediated immunity described
for renal transplant recipients and HIV-infected patients are important
risk factors for the development of HPV-related malignant carcinomas.
Our study describes the occurrence of HPV infection of the skin caused by
genital types instead of the usual skin HPVs 1 and 2. It is interesting to
note that the HPV types detected by NISH are related to persistence and
progression to cancer. These unusual infections may be attributed to
immunological impairment and have to be considered in the management of
immunodeficient patients, due to its oncogenic potential.
Copyright 1998 Fundacao Oswaldo Cruz - Fiocruz
|