Evaluación de tres pruebas serológicas para la detección de anticuerpos contra el virus linfotrópico T humano tipo 1 (HTLV-1)

Introducción: El Perú es endémico al virus linfotrópico T humano tipo 1 (HTLV-1), por esas razones es importante conocer la fiabilidad de las pruebas diagnósticas que se usan en el país, con la finalidad de continuar o no su uso. El objetivo fue evaluar el rendimiento de tres pruebas serológicas ELISA Murex, ELISA Wantai e IFI INS-Perú para la detección de anticuerpos anti HTLV-1 frente a muestras peruanas. El estudio. Las tres pruebas fueron evaluadas frente a 382 sueros: 215 positivos y 167 negativos a HTLV-1 (Gold Standar: inmunoblot). Hallazgos. IFI no presentó falsos positivos, Wantai tuvo más falsos negativos (siete) y Murex más falsos positivos (ocho). Las tres pruebas mostraron resultados superiores a 95% para los parámetros estimados de exactitud diagnóstica. Conclusiones. IFI INS-Perú y ELISA Murex tuvieron buen rendimiento diagnóstico para la detección de anticuerpos contra HTLV-1 y son buenos candidatos para continuar siendo usados en Perú.

Background: Peru is endemic to the human T-lymphotropic virus type 1 (HTLV-1), for these reasons it is important to know the reliability of the diagnostic tests used in the country, in order to continue their use or not. The objective was to evaluate the performance of three serological tests ELISA Murex, ELISA Wantai and IFI INS-Peru for the detection of anti-HTLV-1 antibodies against Peruvian samples. The study. The three tests were evaluated against 382 sera: 215 positive and 167 negative for HTLV-1 (Gold Standard: immunoblot). Findings. IFI had no false positives, Wantai had more false negatives (seven) and Murex more false positives (eight). The three tests showed results above 95% for the estimated parameters of diagnostic accuracy. Conclusions. IIF INS-Perú and ELISA Murex had good diagnostic performance for the detection of antibodies against HTLV-1 and are good candidates to continue being used in Peru.

Transmisión vertical del virus linfotrópico humano en el Hospital del Niño Manuel Ascensio Villarroel de Cochabamba estudio exploratorio

Los virus Linfotrópicos de células T humanas tipo I y II (HTLV) son retrovirus que se encuentran distribuidos a nivel mundial, se caracterizan por la infección de células TCD4+ y se asocian a dos tipos de enfermedades importantes como la leucemia/linfoma de células T adultas (ATLL) y la enfermedad neurológica, paraparesia espástica tropical (PET) o mielopatía. Una de las principales vías de transmisión es la denominada transmisión vertical, de madre a hijo a través de la lactancia materna, cuya tasa de transmisión es de 5,7 a 35,5 %. Objetivos: explorar la transmisión vertical del Virus HTLV en niños de 8 meses a 6 años de edad, que fueron atendidos en el Hospital del Niño Manuel Ascencio Villarroel, en el periodo 2020 -2021. Métodos: estudio cuantitativo, transversal, descriptivo, exploratorio. Resultados: de los 67 pacientes estudiados, una mayoría tiene origen étnico quechua, procedentes del área rural. Al estudio clínico, todos los pacientes presentan un estado nutricional conservado eutrófico (n=55), el promedio de lactancia materna de los mismos es de 17,2 meses. Al estudio laboratorial, un paciente dio positivo para HTLV por la técnica de ELISA, prueba realizada por duplicado en tiempos distintos, el cual corresponde al 1,5 % de los pacientes estudiados. Conclusiones: este estudio exploratorio demuestra fundamentalmente que este virus se encuentra circulando en nuestro medio, en el 1,5 % de la muestra estudiada, lo que hace necesario profundizar el estudio con un mayor número de muestras.

The human T-cell lymphotropic virus type I and II (HTLV) are retroviruses that are distributed worldwide, are characterized by the infection of TCD4+ cells and are associated with two types of important diseases such as adult T-cell leukemia/lymphoma (ATLL) and the neurological disease, tropical spastic paraparesis (TSP) or myelopathy. One of the main routes of transmission is the so-called vertical transmission, from mother to child through breastfeeding, whose transmission rate is 5.7 to 35.5%. Objectives: to explore the vertical transmission of the HTLV Virus in children from 8 months to 6 years of age, who were treated at the Manuel Ascencio Villarroel Children's Hospital, in the period 2020 -2021. Methods: quantitative, cross-sectional, descriptive, exploratory study. Results: of the 67 patients studied, a large part has Quechua ethnic origin, coming from the rural area. Clinically, they present a preserved eutrophic nutritional status (n=55), with an average of 17.2 months of breastfeeding. Of the total number of patients, one tested positive for HTLV by the ELISA technique, which corresponds to 1.5% of the patients studied. Conclusions: this exploratory study basically demonstrates that this virus is circulating in our environment, in 1.5% of the sample studied, which makes it necessary to deepen the study with a greater number of samples.

Htlv-1 na leucemia/linfoma de células-t e abordagem social sobre a infecção / Htlv-1 in t-cell leukemia/lymphoma and social approach to the infection / Htlv-1 en la leucemia/linfoma de células t y el enfoque social de la infección

A Leucemia/Linfoma de Células-T do Adulto (LLCT) é um tipo agressivo de doença linfoproliferativa causada pelo Vírus Linfotrópico de Células-T Humano (HTLV-1), classificada em cinco tipos: indolente, tumoral primária de pele, crônico, linfomatoso e agudo. O HTLV pertence à família Retroviridae, gênero Deltaretrovirus, subfamília Oncovirinae, de três genes estruturais (Gag, Pol e Env) e sua transmissão ocorre por contato sexual, transfusão de sangue ou inoculação por materiais perfuro- cortantes contaminados e aleitamento materno. Esta revisão narrativa tem como objetivo apresentar uma síntese sobre a relação do HTLV-1 na LLCT, seu processo patogênico e uma abordagem social. O vírus infecta, principalmente, células T CD4+, desregulando o sistema imunológico do hospedeiro, podendo ocasionar neoplasia de células-T a partir de uma única célula que teve expansão clonal, constituindo uma população monoclonal em que todas as células contêm o DNA proviral do HTLV-1. O prognóstico é ruim, a maioria dos pacientes que desenvolvem LLCT apresenta doença de progressão rápida e o óbito em curto período, mesmo com quimioterapia agressiva. Não há política nacional específica para o HTLV, não faz parte da lista de doenças de notificação compulsória e pouco se debate publicamente, gerando desconhecimento por parte da população e por parte de profissionais de saúde, sendo uma infecção negligenciada. Conclui-se que a infecção pelo HTLV é um tema que precisa ser popularizado, havendo urgência na implantação de políticas públicas específicas e de pesquisas contínuas, devido à grande incidência no Brasil e associação a doenças graves como a LLCT.

Adult T-Cell Leukemia/Lymphoma (TCLL) is an aggressive type of lymphoproliferative disease caused by the Human T-Cell Lymphotropic Virus (HTLV- 1), classified into five types: indolent, primary skin tumor, chronic, lymphomatous and sharp. HTLV belongs to the Retroviridae family, Deltaretrovirus genus, Oncovirinae subfamily, with three structural genes (Gag, Pol and Env) and its transmission occurs through sexual contact, blood transfusion or inoculation with contaminated sharps and material and breastfeeding. This narrative review aims to present a synthesis about the relationship of HTLV-1 in CLL, its pathogenic process and a social approach. The virus mainly infects CD4+ T cells, disrupting the host's immune system, and may cause T-cell neoplasia from a single cell that underwent clonal expansion, constituting a monoclonal population in which all cells contain the HTLV proviral DNA -1. Prognosis is poor, most patients who develop TCLL have rapidly progressive disease and death within a short period, even with aggressive chemotherapy. There is no specific national policy for HTLV, it is not part of the list of notifiable diseases and little is discussed publicly, generating ignorance on the part of the population and on the part of health professionals, being a neglected infection. It is concluded that HTLV infection is a topic that needs to be popularized, with urgency in the implementation of specific public policies and continuous research, due to the high incidence in Brazil and association with serious diseases such as TCLL.

La leucemia/linfoma de células T del adulto (LLCT) es un tipo agresivo de enfermedad linfoproliferativa causada por el virus linfotrópico de células T humanas (HTLV-1), clasificada en cinco tipos: indolente, tumor primario de piel, crónica, linfomatosa y aguda. El HTLV pertenece a la familia Retroviridae, género Deltaretrovirus, subfamilia Oncovirinae, con tres genes estructurales (Gag, Pol y Env) y su transmisión se da por contacto sexual, transfusión de sangre o inoculación con material cortopunzante contaminado y lactancia materna. Esta revisión narrativa tiene como objetivo presentar una síntesis sobre la relación del HTLV-1 en la LLC, su proceso patogénico y un abordaje social. El virus infecta principalmente a los linfocitos T CD4+, alterando el sistema inmunitario del huésped y puede causar neoplasia de linfocitos T a partir de una sola célula que experimentó expansión clonal, constituyendo una población monoclonal en la que todas las células contienen el ADN proviral -1 del HTLV. El pronóstico es malo, la mayoría de los pacientes que desarrollan LLCT tienen una enfermedad rápidamente progresiva y mueren en un período corto, incluso con quimioterapia agresiva. No existe una política nacional específica para el HTLV, no forma parte de la lista de enfermedades de notificación obligatoria y poco se discute públicamente, generando desconocimiento por parte de la población y por parte de los profesionales de la salud, siendo una infección desatendida. Se concluye que la infección por HTLV es un tema que necesita ser popularizado, con urgencia en la implementación de políticas públicas específicas y de investigación continua, debido a la alta incidencia en Brasil y la asociación con enfermedades graves como la LLCT.

Correlation between serological screening of human T-lymphotropic virus antibodies and confirmatory tests / 中国输血杂志

【Objective】 To explore the correlation between serological screening of human T-lymphotropic virus antibodies (anti HTLV) and Western blot(WB) confirmatory tests among blood donors, so as to explore the infection status of HTLV Ⅰ/Ⅱ in Guangzhou. 【Methods】 The anti HTLV Ⅰ/Ⅱ enzyme-linked immunosorbent assay(ELISA) kit was used to screen voluntary blood donors from Guangzhou Blood Center from July 2016 to August 2022. WB was used to confirm 395 reactive blood samples by ELISA. The correlation between the S/CO values of anti HTLV Ⅰ/Ⅱ ELISA reagents and the confirmatory test was analyzed using ROC curves. 【Results】 The results showed that 25 out of 395 initially screened reactive blood donor samples were confirmed as HTLV positive by WB, while 16 were uncertain. ROC curve analysis showed a correlation between the S/CO values by ELISA and the confirmatory test results: the S/CO value at the highest Youden index was 3.789, which was the optimal threshold. The S/CO value had a certain correlation with the predicted positive rate of confirmatory results (P<0.05): the larger the S/CO value, the higher the predicted positive value. The overall prevalence of HTLV in Guangzhou is relatively low. 【Conclusion】 The prevalence of HTLV among blood donors in Guangzhou is low.Since the false positive rate of HTLV Ⅰ/Ⅱ antibody by ELISA serological screening is high, the confirmatory testing is particularly important.

Mielopatia ou paraparesia espástica tropical (HAM/TSP) e os domínios da SF-36 / Tropical spastic myelopathy/ paraparesis (HAM/TSP) and the SF-36 domains

Introdução: a paraparesia espástica tropical ou mielopatia associada ao HTLV (HAM/TSP) é umadoença infecciosa e inflamatória crônica, que pode interferir em vários aspectos da vida do indivíduo e, com isso, alterar sua qualidade de vida (QV). Objetivo: avaliar os domínios da escala SF-36 que mais contribuem para as alterações na qualidade de vida dos pacientes com HAM/TSP. Metodologia: nesse estudo observacional, transversal e quantitativo, realizado com 49 pacientes diagnosticados com HAM/TSP do setor de Neurociências do Ambulatório Professor Francisco Magalhães Neto, na cidade de Salvador, Bahia, Brasil, a qualidade de vida foi avaliada pelo questionário de saúde Short Form-36 (SF-36), no período de fevereiro de 2019 a julho de 2020, e de fevereiro de 2022 a abril de 2022. Os dados obtidos foram avaliados por análise estatística descritiva e testes de correlação de Pearson e Spearman. Resultados: foi observado que os menores escores do questionário SF-36, indicando pior qualidade de vida, foram relativos aos domínios vinculados às limitações físicas, capacidades funcionais e limitações emocionais, nessa ordem. Os melhores domínios, indicando melhor qualidade de vida, nessa população, foram saúde mental e aspectos sociais, demostrando que os pacientes com HAM/TSP relatam alterações físicas e emocionais em sua qualidade de vida. Conclusão:os domínios que mais alteraram a qualidade de vida dos pacientes com HAM/ TSP foram AF, CF e AE. Assim, utilizando-se da escala SF-36, profissionais de saúde podem identificar e intervir precocemente em domínios que comprometam a saúde física e emocional dos pacientes com HAM/TSP, alterando, consequentemente, sua qualidade de vida.

Introduction: tropical Spastic Paraparesis or HTLV-associated Myelopathy (HAM/TSP) is a chronic infectious and inflammatory disease that can interfere with various aspects of individuals life and, thereby alter their Quality of Life (QoL). Objective: to evaluate the domains of the sf-36 scale that most contribute to changes in the quality of life of patients with HAM/TSP. Methods: in this observational, cross-sectional and quantitative study carried out with 49 patients diagnosed with HAM/TSP from the Neuroscience sector of the Professor Francisco Magalhães Neto Ambulatory, in the city of Salvador, Bahia, Brazil, quality of life was assessed using the Short Form Health Questionnaire Form ­ 36 (SF-36), from February/19 to July/20 and from February/22 to April/22. Data obtained were evaluated by descriptive statistical analysis and Pearson and Spearman correlation tests. Results: it was observed that the lowest scores on the SF-36 questionnaire, indicating worse quality of life, were related to the domains linked to physical limitations, functional capacities and emotional limitations, in that order. The best domains, indicating better quality of life in this population, were mental health and social aspects, showing that patients with HAM/TSP report physical and emotional changes in their quality of life. Conclusion: the domains that most changed the quality of life of patients with HAM/TSP were PA, FC and EA. Thus using the SF-36 scale, health professionals can identify and intervene early in areas that compromise the physical and emotional health of patients with HAM/TSP, consequently altering their quality of life.

Virus linfotrópico humano de células T tipo 1 (HTLV-1) en el embarazo / Human lymphotropic virus in T-cell type 1 (HTLV-1) during pregnancy

El HTLV-1 es un retrovirus que afecta principalmente a los linfocitos T-CD4, causando enfermedades como paraparesia espástica o mielopatía, uveítis, dermatitis infecciosas, leucemia/linfoma de las células T del adulto, además de otras enfermedades. Causa una infección crónica de por vida en humanos y su transmisión ocurre a través de la lactancia materna, el contacto sexual y las transfusiones de sangre. En Chile actualmente ocupa el cuarto lugar en notificaciones entre el año 2014-2021, estimándose a nivel mundial más de 20 millones de portadores. El mayor riesgo de transmisión ocurre por lactancia mayor a seis meses y alta carga proviral y altos títulos de anticuerpos en la madre portadora. El objetivo consistió en analizar la situación de la portación del virus HTLV-1 durante el embarazo, determinando su prevalencia, vías de transmisión y complicaciones. Se realizó una revisión bibliográfica sistemática de artículos publicados en bases de datos científicas referidos al virus HTLV-1. Este virus está globalmente diseminado y se presenta en forma endémica en algunas regiones del mundo con prevalencias entre muy elevadas y bajas. En Chile la seroprevalencia en promedio es de 0,124% para HTLV-1. Esta infección no cuenta con tratamiento, solo se tratan los síntomas por lo que mientras esto no cambie, solo es factible reducir la transmisión, incidencia y la morbilidad del HTLV-1 incorporando medidas de control del virus en las intervenciones de control de enfermedades y estrategias de salud pública. La forma más eficiente de transmisión del virus madre-hijo es a través de la leche materna, es necesario implementar la detección prenatal de HTLV-1, en especial en las zonas endémicas, así como también asesorar a las madres HTVL-1 positivas sobre la lactancia materna.

HTLV-1 is a retrovirus that mainly affects CD4-T lymphocytes, causing diseases such as spastic paraparesis or myelopathy, uveitis, infectious dermatitis, adult T-cell leukemia/lymphoma, and other diseases. It causes a lifelong chronic infection in humans and its transmission occurs through breastfeeding, sexual contact and blood transfusions. In Chile, it currently ranks fourth in notifications between the years 2014-2021, with more than 20 million carriers being estimated worldwide. The greatest risk of transmission occurs by breastfeeding for more than six months and high proviral load and high antibody titers in the carrier mother. The objective consisted of analyzing the situation of the carriage of the HTLV-1 virus during pregnancy, determining its prevalence, transmission routes and complications. A systematic bibliographic review of articles published in scientific databases referring to the HTLV-1 virus was carried out. This virus is globally disseminated and occurs endemic in some regions of the world with prevalence between very high and low. In Chile, the average seroprevalence is 0.124% for HTLV-1. There is no treatment for this infection, only the symptoms are treated, so as long as this does not change, it is only feasible to reduce the transmission, incidence, and morbidity of HTLV-1 by incorporating virus control measures into disease control interventions and strategies. of public health. The most efficient form of mother-child transmission of the virus is through breast milk, it is necessary to implement prenatal screening for HTLV-1, especially in endemic areas, as well as counsel HTLV-1 positive mothers on breastfeeding

Mielopatía asociada a virus linfotrópico humano de células T tipo 1 en el Paraguay. Reporte de caso / Myelopathy associated with human T-cell lymphotropic virus type 1 in Paraguay. Case report

RESUMEN La mielopatía asociada con infección por HTLV-1 o paraparesia espástica tropical es una enfermedad crónica degenerativa del sistema nervioso central que afecta principalmente la médula espinal, una enfermedad rara en nuestro medio. El caso se trata sobre una mujer de 65 años, que acude con un cuadro de 2 años de evolución con disminución de la fuerza muscular de miembros inferiores progresiva hasta impedir la marcha, se acompaña de incontinencia urinaria y fecal, y hormigueo en miembros inferiores. Examen físico neurológico: disminución de fuerza muscular en miembros inferiores (2/5), reflejos osteotendinosos exaltados en miembros inferiores, Babisnky bilateral, hipostesia en cara lateral de piernas y dorso y planta de los pies, clonus patelar, y sin nivel sensitivo. En estudios paraclínicos: líquido cefalorraquídeo con cito químico (proteínas ligeramente aumentada) y citológico normal, ausencia de bandas oligoclonales, serología HIV negativo, perfil autoinmune negativo. Electromiografía normal, tomografía de cráneo, tórax y abdomen normal. Resonancia magnética cerebral y medular normal al principio, los cuales fueron repetidos al cabo de 8 meses y se observan lesiones inflamatorias en cerebro y médula espinal. PCR (reacción en cadena de la polimerasa) en sangre para HLTV-1 positiva. La paciente fue tratada con pulsos de metilprednisolona, seguido de prednisona oral y azatioprina por 3 meses sin respuesta favorable y con efectos secundarios a los corticoides por lo que se suspende. Se inició inmunoglobulina IV 400mg kg/p/mensual por 3 meses, sin respuesta. Se inicia rituximab 500mg cada 15 días hace 1 mes y evaluar la respuesta en los controles sucesivos. Conclusión: La mielopatía asociada a virus linfotrópico humano de células T tipo 1(HTLV-1) o paraparesia espástica tropical (MAH/PET), debe ser considerado en el diagnóstico diferencial en un paciente con mielopatia en el Paraguay.

ABSTRACT Myelopathy associated with HTLV-1 infection or tropical spastic paraparesis is a chronic degenerative disease of the central nervous system that mainly affects the spinal cord, a rare disease in our setting. The case is about a 65-year-old woman, who presented with a 2-year history of progressive decrease in muscle strength of the lower limbs until it prevented her from walking, accompanied by urinary and fecal incontinence, and tingling in the lower limbs. Neurological physical examination: decreased muscle strength in the lower limbs (2/5), increased osteotendinous reflexes in the lower limbs, bilateral Babinky, hypoesthesia in the lateral aspect of the legs and the back and soles of the feet, patellar clonus, and no sensory level. In paraclinical studies: normal cytochemical and cytological cerebrospinal. Fluid (slightly increased protein), absence of oligoclonal bands, negative HIV serology, negative autoimmune profile. Normal electromyography, tomography of the skull, thorax and normal abdomen. Magnetic resonance imaging of the brain and spinal cord was normal at the beginning, which were repeated after 8 months, and inflammatory lesions in the brain and spinal cord were observed. PCR (polymerase chain reaction) in blood for HLTV-1 positive. The patient was treated with methylprednisolone pulses, followed by oral prednisone and azathioprine for 3 months without a favorable response and with corticosteroid side effects, so she was discontinued. IV immunoglobulin 400mg kg/p/monthly for 3 months was started, with no response. Rituximab 500mg every 15 days was started 1 month ago and the response was evaluated in successive controls. Conclusion: myelopathy associated with human T-cell lymphotropic virus type 1 (HTLV-1) or tropical spastic paraparesis (MAH/PET), should be considered in the differential diagnosis in a patient with myelopathy in Paraguay.

Results of a sample-to-cutoff ratio using Abbott Architect rHTLV-I/II assay allow to predict detection of HTLV-1 and HTLV-2 proviral DNA by real-time PCR / Resultados da razão sinal da amostra sobre o cutoff da reação no ensaio Abbott Architect rHTLV-I/II permite prever a detecção de DNA proviral por PCR em tempo real

The present study aims to correlate the sample-to-cutoff ratios (S/CO) distributions of reactive results for HTLV-1/2 antibodies with the detection of proviral DNA in a population of blood donor candidates. It was carried out a retrospective data search of 632 HTLV-1/2 reactive samples, submitted to confirmatory testing from January 2015 to December 2019. Serological screening was performed by chemiluminescent microparticle immunoassay Architect rHTLV-I/II, whereas confirmatory testing was performed by in-house real-time polymerase chain reaction method. 496 out of 632 samples (78%) had undetectable HTLV-1/2 proviral DNA and 136 (22%) had detectable proviral DNA. HTLV infection was not confirmed in any individual for whom the S/CO ratio value was <4, and proviral DNA detection rates gradually escalated as S/CO ratio values increased. The sensitivity and predictive positive value found for the Architect rHTLV-I/II was 100% and 22%, respectively. The receiver operating characteristic (ROC) curve analysis showed that the optimal S/CO ratio value for predicting the presence of HTLV-1/2 was 18.11. High S/CO ratios were more associated with the detection of proviral DNA. The S/CO ratio value <4 suggests excluding true HTLV infection and the risk of blood transmission (AU).

O estudo tem como objetivo correlacionar às distribuições das razões sample-to-cutoff (S/CO) de resultados reagentes para anticorpos HTLV-1/2 com a detecção de DNA proviral em uma população de candidatos à doação de sangue. Realizou-se uma busca retrospectiva de dados de 632 amostras reagentes para HTLV-1/2 submetidas à testagem confirmatória entre janeiro de 2015 a dezembro de 2019. A triagem sorológica foi realizada pelo imunoensaio quimioluminescente de micropartículas Architect rHTLV-I/II, enquanto o teste confirmatório foi realizado pelo método de PCR em tempo real in-house. 496 de 632 amostras (78%) apresentaram DNA proviral indetectável e 136 (22%) apresentaram DNA proviral detectável. A infecção por HTLV não foi confirmada em nenhum indivíduo com valor de S/CO <4 e as taxas de detecção de DNA proviral escalonaram gradualmente à medida que as razões S/CO aumentaram. A sensibilidade e valor preditivo positivo encontrados para o Architect rHTLV-I/II foram 100% e 22%, respectivamente. Utilizando análise de curva ROC, o valor de razão S/CO ideal para predizer a presença de DNA proviral foi de 18,11. Razões S/CO elevadas foram mais associadas à detecção de DNA proviral. Em suma, o valor de S/CO <4 sugere a exclusão de infecção por HTLV e o risco de transmissão pelo sangue (AU).

Linfoma gástrico primario de células T, no asociado a HTLV-1, con metástasis cutánea y neumoperitoneo / Non-HTLV-1-associated primary gastric T-cell lymphoma with cutaneous metastasis and pneumoperitoneum

Introducción: Los linfomas gástricos primarios representan menos del 5% de los linfomas no Hodgkin (LNH). La gran mayoría de linfomas gástricos primarios son linfomas de células B de alto grado. Los linfomas gástricos primarios de células T son muy raros y usualmente se asocian a infección por HTLV-1 en regiones endémicas. Material y método. Describimos el caso de una paciente mujer de mediana edad que se presentó con neumoperitoneo debido a ulcera gástrica perforada, síndrome consuntivo y lesiones cutáneas y orales. Resultados. La histopatología e inmunohistoquímica confirmaron linfoma gástrico primario de células T con compromiso cutáneo. La serología para HTLV-1, virus del Epstein-Barr y VIH fueron negativas. Conclusión. La finalidad de este reporte es dar a conocer esta forma de presentación sumamente rara de linfoma gástrico primario.

Background: Primary gastric lymphomas account for less than5%ofnon-Hodgkinlymphomas(NHL).Thevast majority of primary gastric lymphomas are high-grade B-cell lymphomas. Primary gastric T-cell lymphomas are very rare and are usually associated with HTLV-1 infection in endemic regions. We describe Material and methods.the case of a middle-aged female patient who presented with pneumoperitoneum due to a perforated gastric ulcer, wasting syndrome, and skin and oral lesions. . Results: Histopathology and immunohistochemistry confirmed primary gastric T-cell lymphoma with skin involvement. The serologyfor HTLV-1,Epstein-Barr virus and HIVwere negative. The aim of this report is to present Conclusion: this extremely rare presentation of primary gastric lymphoma

A Therapeutic Experience of Rapid Progressive HTLV-1 Associated Myelopathy in a Convalescent Rehabilitation Ward：A Case Report / The Japanese Journal of Rehabilitation Medicine

The patient was a 76-year-old woman who developed involuntary movements in both hands and gait disorder. Weakness in both lower limbs gradually worsened, and she was referred to our hospital. Neurological findings included spastic paraplegia, deep sensory disturbance, sensory ataxia, and bladder and bowel dysfunction. Approximately 4 months after the onset, she became unable to walk independently and had to use a walker. MRI showed a long spinal cord lesion extending from the cervical to thoracic spinal cord. Blood and spinal fluid samples tested positive for anti-human T-cell leukemia virus type 1 (HTLV-1) antibodies. Given these findings and subacute course, she was diagnosed with rapidly progressive HTLV-1 associated myelopathy (HAM). High levels of neopterin and CXCL10 in the cerebrospinal fluid suggested high disease activity；thus, she underwent steroid pulse therapy followed by treatment with maintenance oral prednisolone in our convalescent rehabilitation ward. After approximately 3 months of muscle strength training, mainly for the trunk muscle and the proximal muscle of the lower limbs, and balance exercise, she was able to walk independently and her activities of daily living (ADL) and instrumental ADL (IADL) improved；however, dysuria persisted. The use of clean intermittent self-catheterization instead of indwelling urethral catheter improved her quality of life (QOL). Although rapidly progressive HAM is generally associated with poor prognosis, steroid therapy combined with comprehensive rehabilitation treatment was effective in the present case.

A Therapeutic Experience of Rapid Progressive HTLV-1 Associated Myelopathy in a Convalescent Rehabilitation Ward：A Case Report / The Japanese Journal of Rehabilitation Medicine

The patient was a 76-year-old woman who developed involuntary movements in both hands and gait disorder. Weakness in both lower limbs gradually worsened, and she was referred to our hospital. Neurological findings included spastic paraplegia, deep sensory disturbance, sensory ataxia, and bladder and bowel dysfunction. Approximately 4 months after the onset, she became unable to walk independently and had to use a walker. MRI showed a long spinal cord lesion extending from the cervical to thoracic spinal cord. Blood and spinal fluid samples tested positive for anti-human T-cell leukemia virus type 1 (HTLV-1) antibodies. Given these findings and subacute course, she was diagnosed with rapidly progressive HTLV-1 associated myelopathy (HAM). High levels of neopterin and CXCL10 in the cerebrospinal fluid suggested high disease activity；thus, she underwent steroid pulse therapy followed by treatment with maintenance oral prednisolone in our convalescent rehabilitation ward. After approximately 3 months of muscle strength training, mainly for the trunk muscle and the proximal muscle of the lower limbs, and balance exercise, she was able to walk independently and her activities of daily living (ADL) and instrumental ADL (IADL) improved；however, dysuria persisted. The use of clean intermittent self-catheterization instead of indwelling urethral catheter improved her quality of life (QOL). Although rapidly progressive HAM is generally associated with poor prognosis, steroid therapy combined with comprehensive rehabilitation treatment was effective in the present case.

The role of IFN-γ production during retroviral infections: an important cytokine involved in chronic inflammation and pathogenesis

ABSTRACT Interferon-gamma (IFN-γ) plays a crucial role in viral infections by preventing viral replication and in the promotion of innate and adaptive immune responses. However, IFN-gamma can exert distinct effects in different persistent viral infections. The long-term overproduction of IFN-γ in retroviral infections, such as the human immunodeficiency virus (HIV), human T-lymphotropic virus type 1 (HTLV-1), and human endogenous retroviruses (HERVs), resulting in inflammation, may cause neuronal damage. This review is provocative about the role of IFN-γ during persistent retroviral infections and its relationship with the causation of some neurological disorders that are important for public health.

Movimentos sociais e políticas públicas - atuação da ONG HTLVida / Social movements and public policies - action of the NGO HTLVida

Resumo Na história contemporânea, diversas formas de organização da sociedade civil têm se destacado na luta por ampliação de direitos. As Organizações Não Governamentais são instituições que se dedicam a reivindicar ampliação de direitos para o grupo pela qual foram criadas. Neste artigo apresentamos a participação da ONG HTLVida no processo de introdução do tema HTLV na agenda governamental na Bahia e militância por ampliação de direitos para esse público. O HTLV é um retrovírus que afeta os linfócitos T e pode causar doenças neurológicas, hematológicas, dentre outras. O Brasil é considerado o país com o maior número absoluto de casos e Bahia é um dos estados com maior prevalência da infecção. Constatamos que vários fatores contribuíram para inclusão do tema na agenda da Bahia e consequente implementação de direitos, dentre esses, a forte militância de indivíduos infectados pelo vírus no grupo HTLVida. Quanto às conquistas, destacamos a estruturação do ambulatório municipal, a criação do Dia Municipal de Enfrentamento do HTLV e a inclusão do tema nas atividades referentes às IST nas secretarias de saúde. Apesar de significativos avanços, o movimento social ainda precisa persistir na mobilização por ampliação de direitos sociais para pessoas vivendo com HTLV.

Abstract In contemporary history, several forms of civil society organizations have stood out in the struggle to expand rights. Non-governmental organizations dedicate themselves to extending the rights of the group for which they were created. This study shows the work of the HTLVida to NGO introduce HTLV to the governmental agenda of Bahia State, Brazil, and to extend rights for this population. HTLV is a retrovirus affecting T lymphocytes which can cause neurological and hematological diseases, among others. Brazil has the highest absolute number of cases and Bahia is one of the states with the highest infection prevalence. We found that several factors contributed to including the topic in the Bahia government agenda and the subsequent implementation of rights; among these, the strong militancy of individuals infected with the virus in the HTLVida group. Regarding their achievements, we highlight the structuring of a municipal outpatient clinic, the creation of the Municipal Day to Confront HTLV, and its inclusion in activities related to STIs in health departments. Despite significant advances, this social movement still needs to persist to mobilize the expansion of social rights for people living with HTLV.

Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain

Abstract Background: Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 +and CD8 +positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain. Methods: Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles. Results: Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls ( p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) ( p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals ( p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group. Conclusion: HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.

Prevalencia de marcadores infecciosos y factores asociados en donantes de un banco de sangre peruano / Prevalence of infection markers and associated factors in donors of a peruvian blood bank

RESUMEN Se buscó determinar la prevalencia de marcadores infecciosos en donantes de un banco de sangre en Perú y valorar si las variables sociodemográficas del donante se asocian con la presencia de estos marcadores. Se realizó un estudio transversal analítico en 5942 donantes de un banco de sangre durante el 2018. Se determinó la positividad a inmunodeficiencia humana (VIH), hepatitis B (VHB), hepatitis C (VHC) y HTLV I-II; además de sífilis y enfermedad de Chagas. La prevalencia de VIH fue 0,81%, VHB 6,19%, VHC 0,12%, HTLV I-II 0,66%, enfermedad de Chagas 2,76% y sífilis 1,73%. Diversos factores sociodemográficos se asociaron con la positividad de marcadores infecciosos. El tipo de donación predominante fue no voluntaria (96%) y el 53% presentó historia de donación previa. Las prevalencias de marcadores infecciosos de VIH, VHB, enfermedad de Chagas y sífilis en los donantes de sangre fueron altas comparadas con otros países de la región.

ABSTRACT We aimed to determine the prevalence of infection markers in donors of a Peruvian blood bank and to assess whether donor sociodemographic variables are associated with the presence of these markers. An analytical cross-sectional study was carried out in 5942 donors of a blood bank, whose data was collected during 2018. Positivity to human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and HTLV I-II was determined, in addition to syphilis and Chagas disease. The prevalence of HIV was 0.81%; for HBV it was 6.19%; for HCV, 0.12%; for HTLV I-II, 0.66%; for Chagas disease, 2.76% and for syphilis it was 1.73%. Several sociodemographic factors were associated with infection markers positivity. The predominant donation type was non-voluntary (96%) and 53% had history of previous donation. The prevalence of infection markers for HIV, HBV, Chagas disease and syphilis in blood donors was high compared to other countries in the region.

Seroprevalence of HTLV-1 and 2 in organ donors and kidney transplant recipients. Colombia 2010-2017

Abstract Since 2004, in Colombia, the detection of human T-cell lymphotropic virus type 1 and 2 (HTLV-1-2) has been recommended for organ donors and recipients. The prevention of HTLV-1 and 2 infection in recipients is important due to its relationship with lymphoproliferative and inflammatory diseases and opportunistic infections. The objective of this study was to describe the seroprevalence of HTLV-1 and 2 among organ donors and kidney transplant recipients between 2010 and 2017 in Colombia. Methods: this was a descriptive study which included 1979 organ donors and 3,311 kidney transplant recipients from the donation and transplant network from 2010 to 2017. The seroprevalence of HTLV-1 and 2 was calculated, and serological and demographic variables were described. Results: out of 1979 donors, detection of antibodies against HTLV-1 was performed in 92% (1820), with a seroprevalence of 0.2%; 50% of the cases were from the Pacific region (an endemic zone in Colombia). Ninety percent of the donors were examined for HTLV-2, with a seroprevalence of 0.2%. Of the 3311 kidney recipients between 2010 and 2017, only 44% were evaluated for HTLV-1 and 43% for HTLV-2. The seroprevalence for both viruses was 0.3%. Two of the HTLV-1 cases were positive for HLADRB1*01. Conclusions: the seroprevalence found in organ donors and kidney transplant recipients was similar to that previously reported in Colombia. Screening of all potential donors must be adhered to prevent transmission of this virus. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2001).

Pessoas vivendo com HTLV: sentidos da enfermidade, experiência do adoecimento e suas relações com o trabalho / People living with HTLV: meanings of the illness, experience of illness and its relationship with work

Resumo Estima-se uma prevalência de 2,5 milhões de pessoas infectadas pelo vírus linfotrópico de células T humanas (HTLV) no Brasil, atingindo sobretudo populações negras e de baixo nível socioeconômico. O artigo apresenta parte dos resultados de pesquisa que objetivou compreender a experiência do adoecimento de pessoas vivendo com HTLV, os modos de andar a vida e as relações com o trabalho. Foram realizadas 31 entrevistas semiestruturadas com usuários de instituto de pesquisa em doenças infecciosas. A análise do discurso utilizou referenciais das Ciências Sociais e as narrativas orais constituíram o corpus analisado com o uso do software Sketch Engine. As manifestações do HTLV trazem prejuízo funcional e influenciam nos modos de andar a vida, repercutindo no trabalho formal, informal e doméstico. As narrativas evidenciaram queixas relativas a sintomas físicos e outros problemas de saúde além de preconceito, falta de apoio familiar e expressivas repercussões no trabalho. As condições materiais, simbólicas e subjetivas dos trabalhadores causadas pela perda progressiva da capacidade física e a aposentadoria precoce afetam não somente a esfera física, assim como a psíquica e social.

Abstract It is estimated that 2.5 million people are infected with the human T-cell lymphotropic virus (HTLV) in Brazil, mainly among afro-descendant populations with low socioeconomic status. The article presents results of the research that aimed to understand the illness experience of people living with HTLV, the ways of going about life and the relationships with work. Thirty-one semi-structured interviews were conducted with frequenters of an infectious diseases research institute. The oral narratives constituted the corpus that was analyzed using Sketch Engine software. Discourse analysis used references from Social Sciences, with emphasis on the health-work relationship. The manifestations of HTLV cause functional impairment and affect living standards, with repercussions on formal, informal, and domestic work. The narratives revealed complaints of physical symptoms and other health-related problems, in addition to prejudice, lack of family support and significant repercussions on work, namely issues aggravated by the absence of public policies aimed at people living with HTLV. The material, symbolic and subjective conditions caused by the progressive loss of physical capacity and early retirement affect not only the physical sphere, but also the psychic and social areas.

Metaanálisis de la validez del inmunodiagnóstico del virus linfotrópico de células T humanas i/ii en bancos de sangre, 2000-2018 / Meta-analysis regarding the validity of the immunodiagnosis of human T-cell lymphotropic virus I/II in blood banks, 2000-2018 / Meta-análise da validade do imunodiagnóstico do vírus linfotrópico de células t humanas I/II em bancos de sangue, 2000-2018

Resumen Objetivo: Evaluar la validez del inmunodiagnóstico del htlv i/ii en bancos de sangre, con base en estudios publicados en la literatura científica. Metodología: Se efectuó un metaanálisis de pruebas diagnósticas siguiendo la guía prisma y las recomendaciones de Cochrane. Se evaluó la calidad metodológica con quadas y se garantizó la reproducibilidad y la exhaustividad. Se realizó también un análisis de efectos aleatorios para la sensibilidad, la especificidad, los cocientes de probabilidad, la razón de momios diagnóstica y la curva característica operativa del receptor (roc) con sus intervalos de confianza (ic) del 95 %. Resultados: Se tamizaron 4604 estudios, de los cuales solo tres cumplieron el protocolo. Se evaluaron 548 infectados con htlv i/ii y 6643 sanos. El inmunodiagnóstico de htlv i/ii presentó una sensibilidad del 99 % (ic95 % = 98,0-99,0), especificidad del 100 % (ic95 % = 99,9-100), cocientes de probabilidad positivo de 315,8 (ic95 % = 128,2-778,5) y negativo de 0,02 (ic95 % = 0,01-0,04), razón de momios diagnóstica de 24373 (ic95 % = 6864-86545) y área bajo la curva roc del 99,9 %. Conclusión: Se dispone de pocos estudios en este campo del inmunodiagnóstico htlv i/ii. El elevado número de sujetos analizados evidenció alta validez del inmunodiagnóstico, lo que resulta determinante para garantizar la inocuidad de las unidades de sangre, la detección de portadores asintomáticos, la disminución de la transmisión y el inicio de tratamiento.

Abstract Objective: To evaluate the validity of the immunodiagnosis of htlv i/ii in blood banks, based on studies published in the scientific literature. Methodology: A meta-analysis of diagnostic tests was carried out following the PRISMA guidelines and Cochrane recommendations. The methodological quality was evaluated with QUADAS, and reproducibility and completeness were guaranteed. A random effects analysis was also performed with respect to sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and receiver operating characteristic curve (ROC) with their 95 % confidence intervals (CI). Results: 4,604 studies were screened, of which only three complied with the protocol. 548 subjects infected with HTLV I/II and 6,643 healthy subjects were evaluated. The immunodiagnosis of HTLV I/II had a sensitivity of 99 % (95 % CI = 98.0-99.0), a specificity of 100 % (95 % CI = 99.9-100), a positive likelihood ratio of 315.8 (95 % CI = 128.2-778.5) and a negative likelihood ratio of 0.02 (95 % CI = 0.01-0.04), a diagnostic odds ratio of 24,373 (95 % CI = 6,864-86,545), and an area under the ROC curve of 99.9 %. Conclusion: Few studies are available in the field of HTLV I/II immunodiagnosis. The high number of subjects analyzed showed high validity of the immunodiagnosis, which is decisive to guarantee the safety of the blood units, the detection of asymptomatic carriers, the decrease in transmission, and the start of treatment.

Resumo Objetivo: Avaliar a validade do imunodiagnóstico do HTLV I/II nos bancos de sangue, baseados nos estudos publicados na literatura científica. Metodologia: Foi realizada uma meta-análise de testes diagnósticos seguindo a guia PRISMA e as recomendações de Cochrane. Foi avaliada a qualidade metodológica com QUADAS e garantiu-se a reprodutibilidade e a integridade. Realizou-se também uma análise de efeitos aleatórios para a sensibilidade, a especificidade, os quocientes de probabilidade, a razão de probabilidade diagnóstica e a Curva Característica de Operação do Receptor (Curva ROC) com seus Intervalos de Confiança (IC) de 95%. Resultados: Foram selecionados 4604 estudos, dos quais somente 3 cumpriram com o protocolo. Foram avaliados 548 infectados com o vírus HTLV I/II e 6.643 saudáveis. O imunodiagnóstico de HTLV I/II apresentou uma sensibilidade de 99% (IC95% = 98,0-99,0), especificidade de 100% (IC95%= 99,9-100), quocientes de probalidade positiva de 315,8 (IC95% = 128,2-778,5) e negativo de 0,02 (IC95% = 0,01-0,04), razão de probabilidade diagnóstica de 24373 (IC95% = 6864-86545) e área sob a curva ROC de 99,9%. Conclusão: São poucos os estudos disponíveis neste campo do imunodiagnóstico HTLV I/II. O elevado número de pessoas analisadas evidenciou alta validade do imunodiagnóstico, o que é decisivo para garantir a inocuidade das unidades de sangue, a detecção de portadores assintomáticos, a diminuição da transmissão e o início do tratamento.

Aplasia medular asociado con virus linfotrópico humano de células T tipo 1 (HTLV-1): Reporte de un caso / Medullary aplasia associated with Human T-Cell Lymphotropic Virus Type 1 (HTLV-1): A Case Report

Antecedentes: La aplasia medular es una enfermedad caracterizada por pancitopenia con médula ósea hipocelular. La mayor parte de estas son adquiridas pudiendo ser idiopáticas o secundarias al daño de la médula ósea producido por agentes físicos, químicos o infecciosos. El HTLV-1 es un retrovirus intracelular que se transmite por la lactancia materna prolongada, las relaciones sexuales y las transfusiones sanguíneas. Descripción del caso: Reportamos el caso de una mujer de 28 años que presentó petequias, gingivorragia y palidez generalizada. En sus exámenes se encontró pancitopenia severa, HTLV-1 positivo y en el aspirado de médula ósea, hipocelularidad marcada. Se administró antibióticos, antifúngicos, antivirales y agentes inmunosupresores con una evolución estacionaria. Conclusiones: La infección por HTLV-1 es frecuente en Perú; sin embargo, su asociación con aplasia medular es poco descrita. El trasplante de células madre hematopoyéticas es una alternativa de tratamiento en caso de no responder a la terapia inmunosupresora.

Background:Medullary aplasia is a disease characterized by pancytopenia with hypocellular bone marrow. Most of these are acquired and can be idiopathic or secondary to bone marrow damage produced by physical, chemical or infectious agents. HTLV-1 is an intracellular retrovirus that is transmitted by prolonged breastfeeding, sexual intercourse, and blood transfusions. Case description: We report the case of a 28-year-old woman who presented petechiae,gingivorrhagia,andgeneralizedpaleness.Inthelaboratory examination, severe pancytopenia was found, HTLV-1 positive, and in the bone marrow aspirate, marked hypocellularity. She received antibiotics, antifungals, antivirals, and immunosuppressive agents with a steady course. Conclusions:HTLV-1 infection is common in Peru; however, its association with medullary aplasia is poorly described. Hematopoietic stem-cell transplantation is an alternative treatment in case of failure to respond to immunosuppressive therapy.

Mielopatía asociada con infección por HTLV-1: paraparesia espástica tropical / Myelopathy associated with HTLV-1 infection: tropical spastic paraparesia

RESUMEN La mielopatía asociada con infección por HTLV-1 o paraparesia espástica tropical (MAH/PET) es una enfermedad crónica degenerativa del sistema nervioso central que afecta principalmente a la médula espinal. Está asociada a la infección por el virus linfotrópico humano tipo 1 (HTLV-1) que pertenece a la familia Retroviridae. América Latina, Asia y África Subsahariana son zonas endémicas de infección por HTLV-1 y MAH/ PET, entre el 2 % y el 17 %, la mayoría asintomáticos. Colombia tiene una alta prevalencia y en especial en su costa pacífica. En las mujeres la infección por HTLV-1 es más prevalente que en los hombres sin que sea clara la causa; se transmite por transfusiones sanguíneas (principalmente de sangre completa), lactancia materna o relaciones sexuales, que es la forma de transmisón más común en pacientes con MAH/PET. La MAH/PET se presenta principalmente en adultos, su periodo de incubación hasta el desarrollo de síntomas varía de dos años hasta décadas. Las principales manifestaciones clínicas de esta enfermedad son la paraparesia y espastici-dad lentamente progresiva que afecta la marcha, asociada con síntomas de esfínteres, como vejiga neurogénica o estreñimiento. Para su diagnóstico se requiere resonancia magnética (RM) de cerebro y médula espinal y la prueba de Elisa, las más usada, con confirmación mediante western blot (WB). En la actualidad no existe un tratamiento específico para la MAH/PET. En el futuro, el uso de biomarcadores ayudará a la detección temprana de la enfermedad e incluso como posible diana terapéutica.

SUMMARY Myelopathy associated with HTLV-1 infection or tropical spastic paraparesis (MAH / PET) is a chronic degenerative disease of the Central Nervous System that mainly affects the spinal cord. It is associated with infection by human lymphotropic virus type 1 (HTLV-1) that belongs to the Retroviridae family. Latin America, Asia and Sub-Saharan Africa are endemic areas of infection by HTLV-1 and MAH / PET between 2 % and 17 %, most asymptomatic. Colombia has a high prevalence and especially on its Pacific coast. In women, HTLV-1 infection is more prevalent than in men without the cause being clear, it is transmitted by blood transfusions (mainly whole blood), breastfeeding and / or sexual intercourse, which is the most common form of transmission in patients with MAH / PET. MAH / PET occurs mainly in adults, its incubation period until the development of symptoms varies from 2 years to decades. The main clinical manifestations of this disease are slowly progressive paraparesis and spasticity affecting gait, associated with sphincter symptoms, such as neurogenic bladder or constipation. For its diagnosis, magnetic resonance imaging (MRI) of the brain, spinal cord and the most used ELISA test are required with confirmation by western blot (WB). Currently there is no specific treatment for HAM / PET. In the future, the use of biomarkers will help early detection of the disease and even as a possible therapeutic target.