Novel insights into human T-lymphotropic virus type-1 (HTLV-1) pathogenesis-host interactions in the manifestation of HTLV-1-associated myelopathy/tropical spastic paraparesis.

Human T-lymphotropic virus type-1 (HTLV-1) was the first discovered human oncogenic retrovirus, the etiological agent of two serious diseases have been identified as adult T-cell leukaemia/lymphoma malignancy and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a debilitating chronic neuro-myelopathy. Despite more than 40 years of molecular, histopathological and immunological studies on HTLV-1-associated diseases, the virulence and pathogenicity of this virus are yet to be clarified. The reason why the majority of HTLV-1-infected individuals (∼95%) remain asymptomatic carriers is still unclear. The deterioration of the immune system towards oncogenicity and autoimmunity makes HTLV-1 a natural probe for the study of malignancy and neuro-inflammatory diseases. Additionally, its slow worldwide spreading has prompted public health authorities and researchers, as urged by the WHO, to focus on eradicating HTLV-1. In contrast, neither an effective therapy nor a protective vaccine has been introduced. This comprehensive review focused on the most relevant studies of the neuro-inflammatory propensity of HTLV-1-induced HAM/TSP. Such an emphasis on the virus-host interactions in the HAM/TSP pathogenesis will be critically discussed epigenetically. The findings may shed light on future research venues in designing and developing proper HTLV-1 therapeutics.

Clinical Features and Survival Outcome in Aggressive-Type Adult T-Cell Leukemia/Lymphoma Patients: Real-Life Experience of a Single Center from an HTLV-1 Endemic Country.

Background and Objectives: Adult T-cell leukemia/lymphoma (ATLL) is a highly aggressive T-cell lymphoproliferative disease associated with the human T-cell lymphotropic virus type I (HTLV-1). ATLL is a rare disease, found more frequently in HTLV-1-endemic areas, Romania being one of them. Despite treatment advances, the prognosis remains dismal. We aimed to describe the clinical, biological, and survival outcome features of Romanian patients with aggressive-type ATLL. Materials and Methods: We report the data of a prospective, observational, and unicentric study of all 20 patients diagnosed with lymphoma and acute types of ATLL at our center over the past 12 years. Data were collected from the patients' medical records. Results: Lymphoma-type ATLL (60%) was more common than acute-type ATLL (40%). Median age at diagnosis was 40.5 years, and most patients were female. Laboratory data revealed significant differences between acute and lymphoma-type ATLL, namely, higher leukocyte (p = 0.02) and lymphocyte counts (p = 0.02) and higher levels of corrected calcium (p = 0.001) in acute-type ATLL. All patients received chemotherapy, and only two underwent allogeneic stem cell transplantation. Only six patients obtained a complete or partial response to chemotherapy, mostly the lymphoma-type ones. The median survival for all patients was 6.37 months, with higher survival in the lymphoma-type ATLL (8.16 months) than in the acute-type (3.60 months). Normal calcium levels (p = 0.011), uric acid (p = 0.005), BUN score (p = 0.000), JCOG-PI moderate risk (p = 0.038), and obtaining complete or partial response (p = 0.037) were associated with higher survival. Conclusion: Aggressive-type ATLL among Romanian patients presents distinct characteristics, including younger age at diagnosis, female predominance, and higher incidence of lymphoma-type ATLL compared to currently reported data. Survival remains very low, with all subtypes experiencing a median survival of less than one year.

Infective dermatitis associated with human T-cell lymphotropic virus type-1, an underdiagnosed disease.

Infective dermatitis associated with human T-cell lymphotropic virus type-1 (HTLV-1) (IDH) is a severe form of chronically infected eczema occurring in early childhood, although very rarely cases have been reported in adults. Most of the cases are from Jamaica and Brazil and occur in individuals with low socioeconomic status. IDH is always associated with refractory Staphylococcus aureus or beta-hemolytic Streptococcus infection of the skin and nasal vestibules. Patients with IDH may develop other even more severe HTLV-1-associated diseases, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) of early or late appearance and adult T-cell leukemia/lymphoma. In the context of the Brazilian experience, it has been observed that 54% of IDH patients exhibit the juvenile form of HAM/TSP while the estimated incidence of adult HAM/TSP is 3%. As there are no curative treatments for HTLV-1 infection (or vaccines) or most of its associated diseases, prevention of infection is fundamental, mainly by vertical transmission, as it is responsible for the development of IDH, infantojuvenile HAM/TSP, and ATL. Public measures to reduce this transmission must be implemented urgently. Furthermore, it is recommended, mainly in HTLV-1 endemic areas, to search for HTLV-1 infection in all patients with infected eczema, even in adults.

Inflammatory progressive multifocal leukoencephalopathy with human T-cell lymphotropic virus-1 coinfection.

A middle-aged man with progressive multifocal leukoencephalopathy (PML) in a human T-cell lymphotropic virus type-1 (HTLV-1) carrier on haemodialysis presented with mild dysarthria and ataxia. Brain MRI revealed asymmetric T2-hyperintense lesions in the cerebral white matter, cerebellum and brainstem. A small amount of JC virus (JCV) genome in cerebrospinal fluid was detected by PCR and cerebellar biopsy demonstrated JCV-DNA presence. Pathological findings showed demyelinating lesions and glial cells with mildly enlarged nuclei, accompanied by T-lymphocytes, neutrophils and plasma cell infiltration. The CD4+/CD8+ratio was 0.83. High-dose corticosteroid therapy was effective for inflammatory PML lesions, and the administration of mefloquine combined with mirtazapine led to favourable outcome. The encephalitis in this case is considered to have occurred secondarily to JCV infection in the presence of HTLV-1 infection. Therefore, it is crucial to investigate the presence of HTLV-1 in order to understand the aetiology of this brain inflammation.

A systematic review of immunosuppressive risk factors and comorbidities associated with the development of crusted scabies.

OBJECTIVES: Crusted scabies (CS, Norwegian scabies) is a severe form of scabies, characterized by hyper-infestation of Sarcoptes scabiei mites. CS is commonly associated with immunosuppression but is also reported in overtly immunocompetent individuals. We reviewed immunosuppressive risk factors and comorbidities associated with CS. METHODS: The National Library of Medicine (PubMed) database was reviewed for patient case reports of CS from January 1998 to July 2023. Two authors screened records for eligibility, extracted data, and one critically appraised the quality of the studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023466126. RESULTS: A total of 436 records were identified, of which 204 were included for systematic review. From these, 683 CS patients were included. CS impacted both genders equally. Adults (21-59 years) were more commonly affected (45.5%) compared to children (0-20 years, 21%). Corticosteroid use was the most prevalent immunosuppressive risk factor identified (27.7% of all cases). About 10.2% of reports were associated with HIV/AIDS, and 8.5% with HTLV-1 infection. 10.5% of patients were overtly immunocompetent with no known risk factors. Overall, 41 (6.0%) died, many subsequent to secondary bacteremia. CONCLUSION: This study represents the first systematic review undertaken on immunosuppressive risk factors associated with CS. This provides insights into trends of immunosuppression and mechanisms of CS development.

Mycobacterium tuberculosis y virus linfotrópico humano, una co-infección fatal / Mycobacterium tuberculosis and human lymphotropic virus, a fatal co-infection

La tuberculosis es una infección de alta incidencia en Latinoamérica. Su presentación como infección activa está determinada por factores de riesgo del hospedero. Comunicamos el caso clínico de una mujer joven que presentó una forma grave de tuberculosis pulmonar. Al explorar sus factores de riesgo se confirmó un estado de inmunosupresión profundo, causado por un linfoma de células T, asociada a una co-infección por virus linfotrópico T humano tipo 1. Se destacan los aspectos microbiológicos y de pronóstico de la co-infección de Mycobacterium tuberculosis y HTLV-1

Tuberculosis is a high-incidence infection in Latin America. Its presentation as an active infection is determined by risk factors in the host. We report the case of a young woman who presented a severe form of pulmonary tuberculosis. When exploring her risk factors, a profound state of immunosuppression was found, caused by T-cell lymphoma, associated with co-infection with human lymphotropic virus. Microbiological and prognostic aspects of Mycobacterium tuberculosis and HTLV-1 co-infection are highlighted.

HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP): Case based discussion of risk factors, clinical, and therapeutic considerations.

HTLV-1 is a retrovirus virus that infects CD4+ T cells. Most people with HTLV-1 infection remain asymptomatic but some may develop conditions such as HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) or adult T-cell leukemia/lymphoma. HAM/TSP is characterized by progressive spasticity and weakness of the lower extremities, as well as loss of bladder control and sensory disturbances. The risk of developing HAM/TSP is associated with the duration of infection and the proviral load. There is currently no cure for the disease but medications can help manage symptoms and slow the progression of the disease. This is the case of a 66-year-old female who presented with nonspecific symptoms of weakness and spasticity in a hospital in Connecticut and was subsequently diagnosed with HAM/TSP. The patient's diagnosis highlights the importance of considering diseases previously confined to specific endemic regions in a globalized world where increased emigration and population mixing can occur. Early identification and management of such cases is essential for optimizing patient outcomes and quality of life.

Case Report: Disseminated Paracoccidioidomycosis and Strongyloides Hyperinfection in a Patient with Human T-Lymphotropic Virus Type 1/2 Infection.

Co-occurrence of paracoccidioidomycosis and strongyloidiasis in immunosuppressed patients, particularly those infected with human T-lymphotropic virus type 1/2, is infrequent. We describe the case of a Peruvian farmer from the central jungle with human T-lymphotropic virus type 1/2 infection, with 2 months of illness characterized by respiratory and gastrointestinal symptoms associated with fever, weight loss, and enlarged lymph nodes. Strongyloides stercoralis and Paracoccidioides brasiliensis were isolated in sputum and bronchoalveolar lavage samples, respectively. The clinical evolution was favorable after the patient received ivermectin and amphotericin B. We hypothesize that autoinfestation by S. stercoralis in human T-lymphotropic virus type 1/2-infected patients may contribute to the disseminated presentation of Paracoccidioides spp. Understanding epidemiological context is crucial for suspecting opportunistic regional infections, particularly those that may coexist in immunosuppressed patients.

Non-cancerous complications in HTLV-1 carriers.

INTRODUCTION: Human T-cell leukemia virus type 1 (HTLV-1) carriers may develop adult T-cell leukemia (ATL), or HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). The evidence is limited regarding other diseases potentially associated with HTLV-1, such as HTLV-1-associated autoimmune diseases. AREA COVERED: We summarized the available information on complications associated with HTLV-1 infection. EXPERT OPINION: Previous studies showed that HTLV-1 carriers have an increased incidence of collagen diseases including Sjögren's syndrome, as well as dysthyroidism, diabetes mellitus, and atherosclerosis. Furthermore, cognitive deficits are observed in asymptomatic carriers and in symptomatic carriers who develop HAM/TSP. It is hypothesized that altered immunoregulation occurs as a result of persistent HTLV-1 infection. A systematic review and meta-analysis demonstrated that HTLV-1 infection itself has an adverse impact on overall survival. ATL alone cannot entirely explain the adverse impact of HTLV-1 infection on overall mortality, because the incidence is low, and therefore HTLV-1-associated diseases as a whole may contribute to the inferior clinical outcome. However, there are insufficient data to determine the causal relationship between HTLV-1 infection and each complication. While non-cancerous events linked to HTLV-1 infection are not fatal, they are likely to reduce quality of life. Large prospective studies should be conducted by international collaborators.

Evolución clínica de la uveítis intermedia asociada a infección por el virus linfotrópico de células T humano tipo 1 (HTLV-1) / Clinical course of HTLV-1 infection associated intermediate uveitis

Objetivo: Describir las características asociadas a la presentación, tratamiento y seguimiento de una serie de casos de uveítis intermedia asociada al virus linfotrópico de células T humano de tipo 1 (HTLV-1).Pacientes y métodosEstudio retrospectivo, descriptivo y longitudinal. Se incluyó a pacientes con uveítis intermedia asociada a infección por HTLV-1 atendidos en una clínica oftalmológica de referencia de Lima (Perú), durante 2012-2018.ResultadosSe incluyó a 18 pacientes (28 ojos). La edad promedio a la presentación fue de 57,3 años; el 66,6% fueron mujeres. El tiempo de seguimiento promedio fue de 1.280 días. Los síntomas más frecuentes fueron visión borrosa o disminuida (78,6%) y visión de cuerpos flotantes (57,1%). La agudeza visual mejor corregida fue de 20/40 o mejor en el 53,6%. La presión intraocular inicial promedio fue de 14,95mmHg. Se observaron precipitados retroqueráticos en el 50% de ojos, siendo el tipo más frecuente el espiculado (17,9% de los ojos). El tratamiento más frecuente fue la inyección periocular de corticoides (en el 53,6% de los ojos). Se presentaron complicaciones como membrana epimacular (50%), catarata (21,4%) y glaucoma (7,1%). Al final del seguimiento, solo 2 ojos perdieron una línea de visión; la agudeza visual mejor corregida final fue de 20/40 o mejor en el 85,7%, y de 20/70 o mejor en el 96,4%. Los pacientes afectados en ambos ojos aumentaron de 33% a la presentación a 55,5%. El curso de la enfermedad fue crónico en el 60,7%.ConclusiónLa uveítis intermedia asociada a infección por HTLV-1 se presentó principalmente en la segunda mitad de la vida, con curso crónico y buen pronóstico visual. (AU)

Objective: To describe the clinical features at presentation, delivered treatment and follow-up of a case series of human T-cell lymphotropic virus type 1 (HTLV-1) associated intermediate uveitis.Patients and methodsRetrospective, descriptive and longitudinal study of patients with HTLV-1 associated intermediate uveitis treated at a reference ophthalmology facility in Lima, Peru, during the years 2012 to 2018.ResultsA total of 18 patients (28 eyes) were included, the average age at presentation was 57.3 years, 66.6% were women, and the average follow-up time was 1,280 days. The most frequent symptoms were blurred or diminished vision (78.6%) and floaters (57.1%). Best corrected visual acuity was 20/40 or better in 53.6%. The mean initial intraocular pressure was 14.95mmHg. Keratic precipitates were observed in 50% of eyes, 17.9% were of the stellate type. The most frequent treatment was periocular corticosteroid injections (53.6%). Complications such as epimacular membrane (50%), cataract (21.4%) and glaucoma (7.1%) occurred. At the end of follow-up, only 2 eyes lost one line of vision; the final best corrected visual acuity was 20/40 or better in 85.7%, and 20/70 or better in 96.4%. Patients with both eyes affected increased from 33% at presentation to 55.5%. The course of the disease was chronic in 60.7%.ConclusionHTLV-1 associated intermediate uveitis mainly occurred in patients in the second half of life, developing a chronic course and with good visual prognosis. (AU)

Possible mechanisms underlying the association between human T-cell leukemia virus type 1 (HTLV-1) and hypertension in elderly Japanese population

BACKGROUND@#Human T-cell leukemia virus type 1 (HTLV-1) activates inflammatory cascades by activating the NF-κB pathway. The minor allele of single nucleotide polymorphism (SNP) in breast cancer suppressor BRCA1-associated protein (BRAP), which has a common etiology with HTLV-1 infection, has been reported to be positively associated with carotid atherosclerosis, but inversely associated with hypertension. Therefore, HTLV-1 infection may be inversely associated with hypertension by activating endothelial maintenance, including atherosclerosis. To clarify these associations, a cross-sectional study was conducted using 2989 Japanese individuals aged 60-99 years participating in a general health check-up.@*METHODS@#Logistic regression models were used to clarify the association between HTLV-1 and hypertension. Platelet levels stratified analyses were also performed since platelet production, which plays a crucial role in endothelium maintenance, can be stimulated by activating the NF-κB pathway.@*RESULTS@#HTLV-1 infection was found to be significantly inversely associated with hypertension, particularly in subjects with high platelet levels (≥ second tertiles of platelet levels); the fully adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were 0.75 (0.62, 0.92) for total and 0.64 (0.50, 0.82) for high platelet levels, respectively. Further analysis of the non-hypertensive subjects demonstrated that HTLV-1 infection was significantly positively associated with atherosclerosis in subjects with the highest tertile of platelet levels (2.11 [1.15, 3.86]) but not in subjects with low platelet levels (first and second tertiles of platelet level) (0.89 [0.57, 1.39]).@*CONCLUSION@#Asymptomatic HTLV-1 infection is inversely associated with hypertension, possibly by activating endothelial maintenance, including atherosclerosis progression.

Comparison of functioning and health-related quality of life among patients with HTLV-1, HIV, and HIV-HTLV-1-coinfection

Abstract INTRODUCTION: Human immunodeficiency virus (HIV) and human T-cell leukemia virus-1 (HTLV-1) viruses are associated with a high global burden of disease, and coinfection is a frequently reported event. We aimed to compare the functioning and health-related quality of life (HRQoL) of patients infected with HTLV-1, HIV, and HIV-HTLV-1. METHODS: We conducted a cross-sectional study of patients older than 18 years who had an HTLV-1 infection (Group A), HIV infection (Group B), or HIV-HTLV-1 coinfection (Group C). The functioning profiles were evaluated using handgrip strength, Berg balance scale (BBS), timed "up and go" (TUG) test, and 5-m walk test (m/s). We used the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire to measure disability. The HRQoL was evaluated using a 36-item short-form health survey. For data with parametric and non-parametric distribution, we used analysis of variance with Bonferroni correction and the Kruskal-Wallis test, followed by Dunn's pairwise tests with Bonferroni correction. RESULTS: We enrolled 68 patients in Group A, 39 in Group B, and 29 in Group C. The scores for handgrip strength, BBS, TUG test, all the WHODAS domains, and HRQoL were poorer for Groups A and C than for Group B. CONCLUSIONS: Compared to patients with HIV infection, those with HIV-HTLV-1 coinfection and HTLV-1 infection had poor functioning and HRQoL scores. HTLV-1 infection was associated with reduced functioning and HRQoL in patients with a single HTLV-1 infection and HIV-HTLV-1 coinfection.

Dermatitis infectiva asociada a HTLV-1: dermatosis a tener en cuenta en pacientes de zonas endémicas / Infective dermatitis associated with HTLV-1: Dermatosis to be considered in patients from endemic áreas

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Limitations in daily activities, risk awareness, social participation, and pain in patients with HTLV-1 using the SALSA and Participation scales

ABSTRACT Background: Tropical spastic paraparesis or HTLV-associated myelopathy (TSP/HAM) may prevent, limit or restrict the performance of daily living activities, and as a consequence, several aspects of life are affected. Objective: The aim of this study was to evaluate activity limitations, risk awareness, social participation, quality of life, and pain in individuals infected with HTLV-1. Methods: This was an observational, descriptive, analytical, cross-sectional study with a quantitative approach. An interview questionnaire, the Screening of Activity Limitation and Safety Awareness (SALSA) scale, the Participation scale, a quality of life questionnaire (SF-36) and the Brief Pain Inventory were used. Results: A total of 55 patients with HTLV-1 were interviewed (62% asymptomatic and 38% symptomatic). In both groups, there was a higher frequency of patients aged 41-50 years old (35.3% asymptomatic and 38.1% symptomatic), with complete secondary education (47.1% asymptomatic and 42.9% symptomatic), and married (64.7% asymptomatic and 52.4% symptomatic). Of the symptomatic patients, 33.3% were retired; among asymptomatic patients, 20.6% performed domestic activities. The majority of patients in both groups had not received blood transfusions. Sexual intercourse was still practiced by patients. After assessment, asymptomatic patients had no activity limitations (64.7%), and symptomatic patients presented limitations (90.5%). None of the groups showed good risk awareness. There was no restriction on social participation in 97.1% of asymptomatic patients and in 52.4% among symptomatics. Both groups complained of pain, being more frequent in the lumbar spine in asymptomatic patients and in the knees in symptomatic patients. Pain was more severe in symptomatic patients and affected aspects of quality of life. Conclusion: The clinical follow-up instruments must be adopted by healthcare professionals to monitor new symptoms so as to avoid the onset of limitations identified in symptomatic patients, in addition to enabling continuous surveillance of asymptomatic patients.

HTLV-1 infection: an emerging risk. Pathogenesis, epidemiology, diagnosis and associated diseases / Infección por HTLV-1: Una enfermedad emergente. Patogenia, epidemiología, diagnóstico y enfermedades asociadas

The Human T-Lymphotropic Virus type 1 (HTLV-1) affects up to 10 million people worldwide. It is directly associated to one of the most aggressive T cell malignancies: Adult T Cell Leukemia-Lymphoma (ATLL) and a progressive neurological disorder, Tropical Spastic Paraparesis/ HTLV-1 Associated Myelopathy (TSP/HAM). Also, infected patients tend to have more severe forms of infectious diseases such as Strongyloidiasis and Tuberculosis. HTLV spreads through parenteral, sexual, and vertical (mother-to-child) routes. Effective viral transmission is produced mainly by cell to cell mechanism, unlike other retroviruses such as HIV, which usually spread infecting cells in a cell-free form. HTLV also has a peculiar distribution, with clusters of high endemicity in nearby areas of very low prevalence or absence of the virus. This could be explained by factors including a possible founder effect, the predominance of mother to child transmission and the cell-to-cell trans-mission mechanisms. More data on viral epidemiology are needed in order to develop strategies in endemic areas aimed at reducing viral dissemination. In this review, we critically analyze HTLV-1 pathogenesis, epidemiology, diagnosis, associated diseases, preventive strategies, and treatments, with emphasis to the emerging risk for Europe and particularly Spain, focusing on prevention methods to avoid viral transmission and associated diseases

El Virus Linfotrópico Humano T tipo 1 (HTLV-1) afecta hasta a 10 millones de personas en todo el mundo. Está directamente asociado a una de las neoplasias malignas de células T más agresivas: Leucemia-Linfoma de células T del Adulto (LLTA) y a un trastorno neurológico progresivo: Paraparesia Espástica Tropical / Mielopatía Asociada a HTLV-1 (PET/MAH). Además, los pacientes infectados tienden a tener formas más graves de enfermedades infecciosas como la Estrongiloidiasis y Tuberculosis. El HTLV se propaga a través de las siguientes vías: parenteral, sexual y vertical. La transmisión viral efectiva se produce principalmente por el mecanismo de contacto directo de célula a célula, a diferencia de otros retrovirus como el VIH, que generalmente se propaga infectando a las células mediante partículas virales libres. El HTLV-1 tiene una distribución peculiar, con grupos de alta endemicidad en áreas cercanas de muy baja prevalencia o ausencia del virus. Esto podría explicarse por factores que incluyen un posible efecto fundador, el predominio de la transmisión vertical (leche materna) y los mecanismos de transmisión por contacto célula a célula. Hoy en día se necesitan más datos epidemiológicos para desarrollar estrategias en áreas endémicas, destinadas a reducir la diseminación viral. En esta revisión, se analiza la patogénesis, la epidemiología, el diagnóstico, las enfermedades asociadas, las estrategias preventivas y los tratamientos del HTLV-1, con énfasis en el riesgo emergente para Europa y particularmente España, centrándonos en los métodos de prevención para evitar la transmisión viral y las enfermedades asociadas

Neurologic complications of HTLV-1: a review / Complicações neurológicas do HTLV: uma revisão HTLV-1

The human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that infects about 20 million people worldwide and causes immune-mediated diseases of the nervous system. The classical neurological presentation of HTLV-1 infection is the so-called HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, HAM/ TSP is not the only neurological outcome that can result from HTLV-1 infection. In this Review it is made an update on the many aspects of this important neurological condition, the HTLV-1 neurological complex.

O vírus linfotrópico de células T humanas tipo 1 (HTLV-1) é um retrovírus que infecta cerca de 20 milhões de pessoas em todo o mundo e causa doenças imunomediadas do sistema nervoso. A apresentação neurológica clássica da infecção pelo HTLV-1 é a chamada paraparesia espástica tropical / mielopatia associada ao HTLV-1 (HAM/TSP). HAM / TSP,no entanto, não é o único desfecho neurológico que pode resultar da infecção pelo HTLV-1. Nesta revisão, é feita uma atualização sobre vários aspectos desta importante condição neurológica, o complexo neurológico do HTLV-1.

Hiperinfección por Strongyloides en paciente de la Patagonia con co-infección por HTLV-1 / Strongyloides hyperinfection in patient from Patagonia with HTLV-1 co-infection

La estrongiloidiasis es una afección desatendida causada por el parásito Strongyloides stercoralis. En los individuos inmunosuprimidos, fundamentalmente en los que tienen depresión de la inmunidad celular, puede desarrollarse el síndrome de hiperinfección por Strongyloides. La coinfección con virus linfotrópico de células T humanas (HTLV) es un factor de riesgo para el desarrollo de formas graves de estrongiloidiasis. Presentamos el caso de un hombre de 50 años con hiperinfección por Strongyloides y coinfección con HTLV. Se demoró el diagnóstico debido a su epidemiología inusual y a la sospecha inicial de enfermedad inflamatoria intestinal. El diagnóstico se confirmó mediante la identificación del parásito en muestras de lavado bronquio-alveolar y biopsias de mucosa duodenal y colónica. Se utilizó ivermectina subcutánea como tratamiento antihelmíntico con adecuada respuesta terapéutica.

Strongylodiasis is an unattended condition caused by the parasite Strongyloides stercoralis. The Strongyloides hyperinfection syndrome can develop in immunosuppressed hosts, mainly in those with depression of cellular immunity. Co-infection with human T-cell lymphotropic virus (HTLV) is a risk factor for the development of severe forms of strongyloidiasis. We present the case of a 50-year-old man with Strongyloides hyperinfection and coinfection with HTLV. The diagnosis was delayed owing to its unusual epidemiology and an initial suspicion of inflammatory bowel disease. Identification of the parasite in bronchioalveolar lavage and duodenal and colonic mucosa biopsies confirmed the diagnosis. Subcutaneous ivermectin was used as an anthelmintic treatment with an adequate therapeutic response.

HTLV 1/2 Prevalence and risk factors in individuals with HIV/AIDS in Pernambuco, Brazil

Abstract INTRODUCTION: Apart from masking the diagnosis of AIDS in patients with HIV/AIDS, human T-cell lymphotropic virus (HTLV), when present, also increases the risk of myelopathies and neurological disease in these patients. METHODS: Disease prevalence was estimated by ELISA and confirmed by Western blot. RESULTS: The coinfection rate was 1.5% (11/720); 10 of 11 patients had HTLV-1, and the remaining one had HTLV-2. The majority were male, over 40 years old, and of pardo color (ethnicity). CONCLUSIONS: There was no association between the risk factors examined and HTLV/HIV coinfection. This is the first study to report the occurrence of HTLV-2 in Pernambuco.

Polymorphism in the interleukin-10 gene is associated with overactive bladder phenotype associated with HTLV-1 infection

Abstract INTRODUCTION Human T-cell lymphotropic virus type 1 (HTLV-1)-associated inflammatory diseases are not well understood; however, their clinical manifestations may be influenced by the host genetic background. METHODS We genotyped 298 individuals with HTLV-1 and 380 controls for interleukin-10 (IL10) gene variants-rs3024496, rs1800871, rs1800896-and used logistic regression analysis to determine their association with clinical phenotypes. RESULTS No association with HTLV-1 infection was observed. However, allele A of rs1800896 (1082bp upstream) was associated with protection against neurological impairment, specifically overactive bladder (OR=0.447, 95% CI 0.28-0.70, p=0.001). CONCLUSIONS Our data suggests that IL10 regulation ameliorates neurological damage in HTLV-1 infections.