Seroepidemiology of HTLV-1 in Neishabour

Human T cell Lymphotropic Virus Type I [HTLV-I] infection has been recognized as the causative agent of two diseases; HTLV-I- associated myelopathy tropical spastic paraparesis [HAM/TSP] and adult T- cell leukemia [ATL]. Approximately 15- 20 millions people are infected with HTLV-I all over the world. The North- East Iran [Mashhad] has been considered as a new endemic area for HTLV- I infection especially Neishaboor. The purpose of this study was the seroepidemiologic study of HTLV-I in Neishaboor. This cross-sectional study was done in Neishaboor in 2002. Neishaboor [without rural areas] is divided into 5 health sections. A total number of 1003 subjects were selected randomly proportional to the population of each region. 5cc of venous blood was obtained from each subject and assessed serologically by Eliza method at immunology laboratory of Ghaem hospital. A questionnaire was provided for data collection of each person. The collected data was analyzed with using of T, Mann Whitney and regression tests. 1- The seroprevalence of HTLV-I infection was 3.4% in Neishaboor [95% CI 2.3-4.5%].2- Male/female ratio was 33/67 in serum positive population. 3- HTLV-I infection was increased with age. 4- As expected the prevalence of infection did not show a uniform distribution throughout the city: a. The most ancient part [region 2] of the city had the highest prevalence [4.9%].b. The rate of infection was more prevalent in the center of city [region 1, 2] in comparison with the peripheral regions of the city [regions 3, 4]. 5- The main risk factors for acquisition of HTLV-I infection are breast feeding, blood transfusion, surgery and sexual transmission. Our results strongly suggest that screening of blood bank donors for HTLV-I infection and limiting of other routes of HTLV-I transmission such as breast feeding, surgery and sexual transmission should be considered to prevent of HTLV-I infection in Neishaboor and other endemic areas

Adult T cell leukemia/lymphoma with lymphopenia in a Korean

We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.