Evaluation of the cervicovaginal environment in asymptomatic Human T-cell lymphotropic virus type 1 infected women

ABSTRACT Introduction: Human T-cell lymphotropic virus type 1 (HTLV-1) is sexually transmitted and causes persistent infection. This virus induces activation of the immune system and production of inflammatory cytokines. This study aimed to assess the cytokine profile and cytopathological findings in the cervicovaginal fluid of asymptomatic HTLV-1-infected women. Methods: HTLV-1-infected and uninfected women were selected at the Centro de Atendimento ao Portador de HTLV in Salvador-Brazil. None of the included HTLV-1-infected women reported any HTLV-1-associated diseases. All volunteers underwent gynecological examination to collect cervicovaginal fluid. Cytokine quantification was performed using the Cytometric Bead Array (CBA) Human Th1/Th2/Th17 kit. Light microscopy was used to evaluate cervicovaginal cytopathology. In addition, proviral load in cervicovaginal fluid and peripheral blood was measured by real-time quantitative polymerase chain reaction. Results: 112 women (63 HTLV-1-infected and 49 uninfected) were evaluated. No differences were found with respect to cytopathological cervicovaginal findings between the groups. IL-2, TNF, IL-4, IL-10, and IL-17 levels were significantly higher in cervicovaginal fluid of the HTLV-1-infected women than in uninfected women (p < 0.05). Conversely, IFN-γ was found to be lower in the HTLV-1-infected women (p < 0.001) compared to uninfected individuals. Cervicovaginal proviral load was detectable in 53% of the HTLV-1-infected women and was found to be consistently lower than the proviral load in peripheral blood. Conclusions: HTLV-1 infection induces immune activation in cervicovaginal environment, characterized by elevated concentrations of Th1, Th2, and IL17 in the cervicovaginal fluid.

Onabotulinumtoxin type A improves lower urinary tract symptoms and quality of life in patients with human T cell lymphotropic virus type 1 associated overactive bladder

ABSTRACT Aim: To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL). Methods: Case series with 10 patients with overactive bladder refractory to conservative treatment with anticholinergic or physical therapy. They received 200Ui of onabotulinumtoxin type A intravesically and were evaluated by overactive bladder symptoms score (OABSS) and King's Health Questionnaire. Results: The mean (SD) of the age was 52 + 14.5 years and 60% were female. All of them had confirmed detrusor overactivity on urodynamic study. Seven patients had HAM/TSP. The median and range of the OABSS was 13 (12-15) before therapy and decreased to 1.0 (0-12) on day 30 and to 03 (0-14) on day 90 (p < 0.0001). There was a significant improvement in 8 of the 9 domains of the King's Health Questionnaire after the intervention. Hematuria, urinary retention and urinary infection were the complications observed in 3 out of 10 patients. The mean time to request retreatment was 465 days. Conclusion: Onabotulinum toxin type A intravesically reduced the OABSS with last long effect and improved the quality of life of HTLV-1 infected patients with severe overactive bladder.

Prolonged lymphocytosis as the first manifestation of Hodgkin-like adult T-cell leukemia/lymphoma

Abstract Hodgkin-like ATLL is a rare variant of adult T-cell leukemia/lymphoma (ATLL), a disease caused by human T-cell lymphotropic virus type-1 (HTLV-1). At admission, a 46-year-old female presented with lymphadenomegaly, lymphocytosis, slight elevation of LDH blood level, and acid-alcohol resistant bacilli in sputum and was being treated for pulmonary tuberculosis (Tb). She had lymphocytosis in the previous 20 months. Serology for HTLV-1 was positive. Lymph node was infiltrated by medium-sized lymphocytes with scattered Hodgkin and Reed-Sternberg-like cells CD30+, CS1-4+, and CD79a+. Background cells were CD4+ and CD25+. A clinical diagnosis of favorable chronic ATLL was given. She was treated with chemotherapy but later progressed to acute ATLL and ultimately died. Hodgkin-like ATLL should be considered in the histological differential diagnosis with Hodgkin lymphoma since treatment and prognosis of these diseases are distinct. It is also important to search for HTLV-1 infection in patients with unexplained prolonged lymphocytosis.

Comorbidity between HTLV-1-associated adult T-cell lymphoma/leukemia and verrucous carcinoma: a case report / Comorbilidad entre carcinoma verrugoso y linfoma/leucemia de células T del adulto asociado con HTLV-1: un reporte de caso

Abstract Background: Adult T-cell Leukemia/Lymphoma (ATLL) is classified as a peripheral CD4+ T-cell neoplasm caused by the human T-cell lymphotropic virus type 1 (HTLV-1). Typical symptoms are associated with leukemic infiltration; however, atypical and exaggerated manifestations of verrucous carcinoma have also been described. Case report: We present here the case of a patient with multiple skin lesions, ischemic necrosis in the hallux and lymphadenopathies. Biopsies were taken, which showed verrucous epidermal carcinoma and cutaneous lymphoma. Splenomegaly and adenopathy in mesentery, retro peritoneum and lymph node chains in the limbs were observed. Bone marrow examination showed findings compatible with T-cell leukemia/lymphoma; and it was ELISA positive for HTLV-1/2. Treatment and outcome: The patient had a good initial response to a CHOP scheme (cyclophosphamide, doxorubicin, vincristine and prednisone) with filgrastim. However, the patient had a relapse and died before the second cycle. Clinical relevance: Comorbidity could lead to the associated risk factors model. According to this model, secondary immunodeficiency caused by HTLV-1 may induce the development of verrucous carcinomas; alternatively, the disease could be due to a correlation between HTLV-1 and the human papillomavirus (HPV).

Resumen Antecedentes: La leucemia/linfoma de células T del adulto se clasifica como una neoplasia de células T CD4+ periféricas desencadenada por el virus linfotrópico de células T humanas tipo 1 (HTLV-1). Los síntomas típicos se asocian a la infiltración leucémica; sin embargo, también se ha descrito la manifestación atípica y exagerada de carcinomas verrugosos. Caso clínico: Se presenta el caso de una paciente con lesiones múltiples en piel, necrosis isquemica del hallux y linfadenopatías. se realizaron biopsias que reportaron carcinoma epidermoide verrugoso y linfoma cutáneo. Se detectó esplenomegalia y adenopatías en mesenterio, región retroperitoneal, y cadenas ganglionares de las extremidades. la medula ósea presentó hallazgos compatibles con leucemia/linfoma de células T y ELISA positivo para HTLV-1/2. Tratamiento y resultado: La paciente presentó buena respuesta inicial al esquema CHOP (ciclofosfamida, doxorrubicina, vincristina, prednisona) con filgrastim. Sin embargo, presentó recaída de la enfermedad antes del segundo ciclo y falleció Relevancia clinica: La comorbilidad podría conducir al modelo de factores de riesgo asociados. De acuerdo con este modelo, la inmunodeficiencia secundaria causada por HTLV-1 puede inducir el desarrollo de carcinomas verrugosos; Alternativamente, la enfermedad podría deberse a una correlación entre el HTLV-1 y el virus del papiloma humano (VPH).

Padronização do critério de exclusão para o vírus HTLV I e II nos bancos de olhos do Brasil / Standardization of the exclusion criteria for the HTLV I and II in brazilian eye banks

RESUMO Objetivo: Investigar em quais Bancos de olhos do Brasil o HTLV I e II é utilizado como critério de exclusão para córnea. Atualmente a legislação brasileira pela Lei nº 9.434/97 e Portaria 2600/09 determina que a cada doação devem ser realizados, obrigatoriamente, testes laboratoriais de triagem de alta sensibilidade, para detecção de marcadores para doenças infecciosas transmissíveis pelo sangue: Vírus da Imunodeficiência Humana (HIV), Vírus da Hepatite B (HbsAg), Anticorpo do Vírus da Hepatite B (AntiHBs), Anticorpo do Vírus da Hepetite B total (Anti-HBc total) e Vírus da Hepatite C (Anti-HCV), no entanto, o Capítulo VI, art. 47, alínea a exclui o Vírus Linfotrópico das Células T-Humanas (HTLV) como critério de exclusão para doadores de córnea. Métodos: Para a realização da pesquisa, foram analisadas as informações de 35 Bancos de Olhos pela base de dados da Central de Transplante da Paraíba, avaliados através do Teste de Homogeneidade do Qui-Quadrado. Resultados: Constatou-se que a sorologia positiva para HTLV I e II foi considerada critério de exclusão em 18 dos 35 Bancos de Olhos analisados. Quanto à análise geográfica dos Bancos de Olhos do Brasil, os da região Nordeste e Sul foram os que mais consideraram o HTLV como critério de exclusão. Conclusão: Os Bancos de Olhos analisados não apresentaram diferença ou associação significativa entre os que consideram e os que não consideram este critério, mostrando, desta forma, não haver uma padronização entre os Bancos de Olhos do Brasil.

ABSTRACT Objective: Investigate in which eye banks in Brazil the HTLV I and II is used as exclusion criteria for cornea. Nowadays Brazilian Legislation, through Law nº 9.434/97 and Ordinance 2600/09 determines that for each donation, laboratory screening tests of high sensibility must be done mandatorily for detection of markers of infectious diseases transmissible by blood: Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HbsAg), Antibody of the Hepatitis B Virus (AntiHBs), Antibody of total Hepatitis B Virus (total Anti- HBc) and Hepatitis C Virus (Anti-HCV), however, paragraph a of Chapter VI, Art. 47 excludes the HTLV as exclusion criteria for cornea donors. Methods: For the realization of this research, information from 35 eye banks was analyzed, through the database of the Transplant Central of Paraiba, evaluated through the Chi-Square Homogeneity Test. Results: It was observed that the positive serology for HTLV I and II was considered exclusion criteria in 18 of the 35 eye banks analyzed. In relation to the geographic analysis of the Eye Banks in Brazil, the ones in the Northeastern and Southern regions were the ones that most considered the HTLV as exclusion criteria. Conclusion: The analyzed Eye Banks did not present difference or significant association between the ones that consider and the ones that do not consider this criterion, showing, this way, that there is not a standardization among the Eye Banks in Brazil.

Serological and virological evaluation of human T-lymphotropic virus type 1 infection in family groups from Tumaco, Colombia / Evaluación serológica y virológica de la infección por el virus linfotrópico de células T humanas de tipo 1 en grupos familiares de Tumaco, Colombia

Introduction: To date there has been no statistical evaluation of the profiles of immunoglobulin classes and viral replication as variables in the study of HTLV-1 infection and circulation among families in virus-endemic areas of Colombia. Objective: To evaluate the correlation of several immunological and molecular characteristics with the transmission and circulation of HTLV-1 among families in the town of Tumaco. Materials and methods: Plasma levels of HTLV-1 specific immunoglobulin classes IgG, IgM and IgA1, as well as IgG and sIgA in oral fluids, were calculated for 32 members of 10 family groups from Tumaco in which the mother and at least one child were infected with the virus. Levels of the different immunoglobulin classes were correlated with viral RNA circulating in plasma or oral fluids and the proviral burden as detected by RT-PCR. Results: Significant differences were determined between mothers and carrier children for immunoglobulin levels (p=0.037) and proviral burden (p=0.002). The overall estimate of IgG in plasma and sIgA in oral fluids could be correlated with the circulation of free viral RNA in both fluids and high proviral burden, and associated with HAM/TSP mothers. The detection of anti- tax IgG in plasma revealed differences between HAM/TSP mothers and their offspring. Conclusion: The study of immunological and molecular variables permitted the analysis of HTLV-1 circulation among families of Tumaco. The strong correlation between levels of IgM specific for the virus and viral RNA circulating in fluids indirectly confirmed the transmission of HTLV-1 among families.

Introducción. Todavía no hay una evaluación estadística de los perfiles de las clases de inmuno- globulina s y la replicación viral, como variables para estudiar la infección y la circulació n del HTLV-1 en familias de zonas endémicas en Colombia. Objetivo. Evaluar la correlación de varias características inmunológicas y moleculares, con la transmisión y circulación del virus en familias del municipio de Tumaco. Materiales y métodos. Se calcularon los niveles de IgG, IgM e IgA1 en plasma, e IgG y IgA secretoria en fluido oral, de 32 miembros de 10 grupos familiares de Tumaco, en los que la madre y, al menos, un hijo estaban infectados con el virus. La concentración de las diferentes clases de inmunoglobulinas se pudo correlacionar con la circulación de ARN viral libre en plasma y fluido oral, y la carga proviral, según su detección mediante reacción en cadena de la polimerasa de transcripción inversa. Resultados. Se encontraron diferencias significativas en los niveles de inmunoglobulinas (p=0,037) y en la carga proviral (p=0,002) entre madres e hijos portadores. La estimación total de IgG en plasma e IgA secretoria en fluido oral, se pudo correlacionar con la circulación de ARN viral libre en ambos fluidos y una alta carga proviral, y se asoció con las madres paraparesia espástica tropical o mielopatía asociada con el HTLV-1. La detección en plasma de IgG anti-Tax reveló diferencias entre ellas y sus hijos. Conclusión. El estudio de las variables inmunológicas y moleculares permitió analizar la circulación del HTLV-1 en familias de Tumaco. La fuerte asociación entre los niveles de IgM específica para el virus y el ARN viral circulante en los fluidos y la carga proviral, confirmó indirectamente la transmisión intrafamiliar del virus.

Concentrações plasmáticas de citocinas e quimiocinas na infecção pelo HTLV-1 / Plasma concentrations of cytokines and chemokines in HTLV-1

INTRODUÇÃO: O vírus linfotrópico das células T humano tipo 1 (HTLV-1) é endêmico na Bahia e está associado com doenças graves, como a Paraparesia Espástica Tropical/Mielopatia associada ao HTLV-1 (HAM/TSP) e a Dermatite Infecciosa associada ao HTLV-1 (DIH). Escassos trabalhos tem sido reportados com a avaliação de citocinas e quimiocinas em indivíduos jovens infectados pelo HTLV-1 e não existem dados sobre a manifestação simultânea DIH e HAM/TSP na faixa infanto-juvenil. OBJETIVO: Avaliar as concentrações plasmáticas de citocinas e quimiocinas na infecção pelo HTLV-1 em indivíduos infanto-juvenis. MÉTODO: Foram incluídos 61 indivíduos portadores do HTLV-1 distribuídos nos grupos Portadores assintomáticos, pacientes com a DIH, pacientes com DIH/HAM/TSP, pacientes com a HAM/TSP e 20 indivíduos saudáveis sem a infecção pelo HTLV-1, todos na faixa infanto-juvenil. As concentrações plasmáticas foram comparadas através do método de Elisa e de Cytometric Bead Array (CBA)...

INTRODUCTION: The lymphotropic virus of cells T human type 1 (HTLV ) is endemic in Bahia and it is associated with serious diseases such as Tropical Spastic Paraparesis/associated myelopathy with HTLV-1 and Infectious Dermatitis associated with HTLV -1 (IDH). Very little work has been reported with the evaluation of cytokines and chemokines in the IDH and there has been no data on the manifestation simultaneous IDH and HAM/TSP in children and youth range. OBJECTIVE: To evaluate the plasma concentrations of cytokines and chemokines in HTLV-1 infection in children and young individuals. METHOD: We included 61 individuals HTLV-1 spread in groups Asymptomatic Carriers, patients with IDH, patients with IDH/HAM/TSP, patients with HAM/TSP and 20 healthy individuals without HTLV-1, all in children's range. Plasma concentrations were compared using the ELISA method and Cytometric Bead Array (CBA)...

Detección de virus linfotrópico de células T humano-I/II en pacientes con enfermedades de transmisión sexual de Santiago / Human T-lymphotropic virus I/II detection in Chilean patients from Sexually Transmitted Diseases clinics

Background: The human T-lymphotropic virus I (HTLV-I) causes spastic para-paresis and adult T-cell leukemia/lymphoma. It can be sexually transmitted and is highly prevalent in Central and South America. Aim: To study HTLV-I/IIprevalence in serum samples obtained from two Sexually Transmitted Diseases (STD) clinics. Material and Methods: Two hundred serum samples were randomly chosen from two reference STD centers of Santiago. The presence of specific HTLV I/II antibodies was detected by indirect immunofluorescence. Results: The analyzed samples came from participants aged 14 to 70 years. Forty nine percent were women and 76% were heterosexual. Only one of the 200 samples was positive (0.5%) and it came from a 70 year-old woman, housewife, with a stable single partner, a history of recurrent genital ulcers, VDRL (-) and positive serology for herpes simplex virus. Conclusions: The prevalence of HTLV-I found in this group is similar to that demonstrated in other populations in Chile, except for aboriginal populations, and similar to international STD studies. Our data is consistent with the low transmissibility by sexual contact.

HTLV 1 associated adult T cell lymphoma/leukemia a clinicopathologic, immunophenotypic tale of three cases from non-endemic region of south India.

Adult T cell lymphoma/leukemia is a peripheral T-cell neoplasm caused by human T-cell lymphotrophic virus-1, affects mostly adults with systemic involvement and poor prognosis. Diagnosis of adult T-Cell leukemia/Lymphoma is challenging. The clinico-pathologic and immuno-phenotypic features of the three cases will be presented.

HTLV II em doadores de sangue na Hemorrede do Ceará - HEMOCE / HTLV-II in blood donors at the Blood Center Net of Ceará - HEMOCE

OBJETIVO: O objetivo do trabalho foi identificar a prevalência do HTLV-II em doadores de sangue da Hemorrede do Ceará e aspectos epidemiológicos de casos positivos. MÉTODOS: Foram levantados em bancos de dados os casos considerados positivos, através de método Imunoenzimático (ELISA) e confirmados pelo Western Blot, no período de 2001 a 2008. Foram identificados que 679.610 amostras de sangue de doadores voluntários foram testadas neste período. RESULTADOS: Do total de doadores, 164 amostras foram efetivamente positivas em ambos os testes, destes 33 (20,1 por cento) foram tipadas como HTLV II, mostrando uma prevalência do último de 0,006 por cento. Nos casos positivos, observou-se idade média de 28,2 anos, o sexo predominantemente masculino (54,5 por cento), a cor foi considerada mulato/parda em 78,8 por cento, a maioria procedia de Fortaleza (72,7 por cento), sendo 51,5 por cento casados/união consensual e 33,3 por cento referiam ter ensino médio completo. CONCLUSÃO: Embora a infecção por HTLV-II seja baixa, sua presença é universal, sendo semelhante entre homens e mulheres, em sua maioria de centro urbano. É enfatizada a necessidade de medidas de prevenção como forma de evitar a expansão da infecção.

OBJECTIVE: To identify HTLV-II revalence in blood donors at the Blood Center Net of Ceará (Hemorrede do Ceará - HEMOCE) and epidemiological aspects of positive cases. METHODS: Cases considered positive were surveyed from data bases through the immunoenzymatic method ELISA and confirmed by Western Blot from 2001 to 2008. In this period, 679,610 blood samples from voluntary donors were tested. RESULTS: From all donors, 164 samples were actually positive in both tests; of these, 33 (20.1 percent) were typed as HTLV-II, showing a prevalence of 0.006 percent. In positive cases, a mean age 28.2 years, and a predominantly male gender (54.5 percent) were observed, the race was mixed in 78.8 percent, most donors had Fortaleza as hometown (72.7 percent), with 51.5 percent being married/consensual union, and 33.3 percent reported to have completed high school education. CONCLUSION: Although HTLV-II infection is low, its presence is universal, being similar in males and females mostly in urban centers. The need of preventive measures as a way of avoiding infection spread is stressed.

Seroprevalencia de HTLV-1/2 en donantes de sangre de la Provincia de Misiones / Seroprevalence of HTLV-1/2 in blood donors from Misiones Province

El Virus Linfotrópico T Humano tipo 1 (HTLV-1), primer oncorretrovirus humano descubierto, es el causante etiológico de la leucemia de células T del adulto (ATL) y de la mielopatía asociada al HTLV-1 o paraparesia espástica tropical (HAM/TSP). Es endémico en distintas partes del mundo, inclusive en el noroeste argentino, donde ambas enfermedades fueron detectadas. El HTLV-2, no tiene un rol etiológico definido, si bien ha sido asociado con síndromes neurológicos similares a la HAM/TSP. Ambos virus son endémicos en comunidades originarias del continente americano, tribus de Africa y poblaciones en riesgo. Ambos retrovirus se transmiten por vía sexual, parenteral y de madre a hijo. El objetivo de este trabajo fue determinar la seroprevalencia de HTLV-1/2 en una población de donantes de sangre de la provincia de Misiones. Se analizaron 6912 donaciones de sangre recibidas en el Banco de Sangre Central de la Provincia de Misiones durante 2008. La detección de anticuerpos se realizó por ELISA y aglutinación de partículas, y las muestras reactivas fueron confirmadas por Western Blot. Del total de muestras, 5 resultaron seropositivas con una prevalencia final de 0.00072. De ellas, una era HTLV, tres HTLV-1 y una HTLV-2 positiva. Los donantes positivos provenían de Posadas, Eldorado y Oberá, sin antecedentes de riesgo. Este estudio demuestra la presencia de HTLV-1/2 en donantes de sangre de Misiones, con cifras similares a las notificadas en donantes de sangre de zonas no endémicas.

Human T-cell Lymphotropic viruses type 1 (HTLV-1), the first human oncoretrovirus to be discovered, is the etiologic agent of Adult T-cell Leukemia (ATL) and HTLV-1 Associated Mielopathy or Tropical Spastic Paraparesis (HAM/TSP). It is endemic worldwide, including the North of Argentina where both associated diseases have also been detected. No etiologic role has been described for HTLV-2, although it has been associated with HAM/TSP-like neurologic syndromes. Both retroviruses are endemic in native populations of The Americas, Africa and at-risk populations. They are transmitted through sex contact, parenterally and from mother to child. The aim of this study was to estimate the seroprevalence of HTLV-1/2 in a blood donor population from Misiones province. A total of 6912 accepted blood donations in 2008 were analyzed. HTLV-1/2 screening was performed with ELISA and particle agglutination, and reactive samples were confirmed by Western Blot. From the total, 5 samples resulted seropositive with a final prevalence of 0.00072. Out of the 5 positive samples, one was an HTLV, three HTLV-1 and one HTLV-2. These blood donors were residents of Posadas, Eldorado and Oberá, with no risk antecedents. This study demonstrates the presence of HTLV-1/2 in a population of Misiones with a prevalence rate similar to those reported among blood donors from non-endemic areas.

Infección por el HTLV-I en pacientes con síndromes linfoproliferativos en dos sitios centinela de Cuba / Human T-cell lymphotropic virus type I infection in patients with lymphoproliferative disorders at two sentinel sites in Cuba

OBJETIVO: Determinar la frecuencia de la infección por el HTLV-I en pacientes con síndromes linfoproliferativos, así como en sus familiares y contactos sexuales, en dos sitios de vigilancia centinela en Cuba. MÉTODOS: Se analizaron todos los pacientes que tenían un diagnóstico presuntivo de neoplasias hematológicas entre enero de 1996 y enero de 2007 atendidos en los servicios de hematología del Hospital Hermanos Ameijeiras (HHA), de Ciudad de La Habana, y el Hospital Provincial Comandante Faustino Pérez (HPCFP), de Matanzas, Cuba. Se determinó la seropositividad al HTLV-I por ELISA y western blot y se confirmó la infección mediante la reacción en cadena de la polimerasa. Se estudiaron también los familiares y los contactos sexuales de los pacientes positivos. Se utilizó la prueba de la Z para la comparación de proporciones. RESULTADOS: La seroprevalencia de la infección por el HTLV-I en pacientes con síndromes linfoproliferativos fue de 0,4 por ciento, mayor en el HPCFP que en el HHA (6,1 por ciento frente a 0,2 por ciento; P < 0,001). No se encontraron diferencias significativas en la frecuencia de la infección según la edad, el sexo y el color de la piel. De los 53 familiares y contactos sexuales estudiados, 8 (15,1 por ciento) tuvieron diagnóstico positivo de infección por el HTLV-I. CONCLUSIÓN: La frecuencia de la infección por el HTLV-I en el grupo estudiado fue superior a la encontrada con anterioridad en Cuba. Se confirmó la utilidad de la vigilancia seroepidemiológica mediante centros centinela.

OBJECTIVE: To determine the prevalence of human T-cell lymphotropic virus type I (HTLV-I) infection among patients with lymphoproliferative disorders, as well as among their family members and sexual contacts, at two sentinel sites in Cuba. METHODS: An analysis was conducted of all the patients with a presumptive diagnosis of hematological malignancies seen by the hematology departments of the Hospital Hermanos Ameijeiras (HHA), City of Havana, and the Hospital Provincial Comandante Faustino Pérez (HPCFP), Matanza, Cuba, in January 1996-January 1997. HTLV-I seropositivity was determined by ELISA and Western Blot, and infection was confirmed by polymerase chain reaction. The positive patients' family members and sexual contacts were also assessed. The Z-test was used to compare proportions. RESULTS: Seroprevalence of HTLV-I infection in patients with lymphoproliferative disorders was 0.4 percent higher at the HPCFP than at the HHA (6.1 percent versus 0.2 percent, P < 0.001). There were no significant differences in prevalence by age, sex, or skin color. Of the 53 family members and sexual contacts studied, 8 (15.1 percent) were positive for HTLV-I infection. CONCLUSION: The prevalence of HTLV-I in the study group was higher than previously found in Cuba. The value of seroepidemiological surveillance through sentinel sites was confirmed.

High HTLV-1 proviral load, a marker for HTLV-1 associated myelopathy/tropical spastic paraparesis, is also detected in patients with infective dermatitis associated with HTLV-1

Salvador (BA, Brazil) is an endemic area for human T-cell lymphotrophic virus type 1 (HTLV-1). The overall prevalence of HTLV-1 infection in the general population has been estimated to be 1.76%. HTLV-1 carriers may develop a variety of diseases such as adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH). IDH is a chronic and severe form of childhood exudative and infective dermatitis involving mainly the scalp, neck and ears. It has recently been observed that 30% of patients with IDH develop juvenile HAM/TSP. The replication of HTLV-1 has been reported to be greater in adult HAM/TSP patients than in asymptomatic HTLV-1 carriers. In the current study, the proviral load of 28 children and adolescents with IDH not associated with HAM/TSP was determined and the results were compared to those obtained in 28 HTLV-1 adult carriers and 28 adult patients with HAM/TSP. The proviral load in IDH patients was similar to that of patients with HAM/TSP and much higher than that found in HTLV-1 carriers. The high levels of proviral load in IDH patients were not associated with age, duration of illness, duration of breast-feeding, or activity status of the skin disease. Since proviral load is associated with neurological disability, these data support the view that IDH patients are at high risk of developing HAM/TSP.

Aislamiento del virus linfotrópico de células T humano tipo I de un paciente con paraparesia espástica tropical: primer reporte en Cuba / Isolation of human T cell lymphotropic virus type 1 from a patient affected by tropical spastic paraparesis: first report in Cuba

Introducción: la paraparesia espástica tropical o mielopatía asociada a HTLV-I (PET/MAH) es una afección neurológica crónica etiológicamente ligada al virus linfotrópico de células T humano tipo I (HTLV-I). Objetivo: realizar la confirmación serológica de la infección y el aislamiento del virus linfotrópico de células T humano tipo I, a partir de las células mononucleares de sangre periférica, de una paciente con un cuadro clínico compatible con paraparesia espástica tropical. Métodos: las células mononucleares de sangre periférica se cocultivaron durante 35 d. La detección viral se realizó por inmunofluorescencia específica de membrana y reacción en cadena de la polimerasa para los genes tax, pol y gag. Resultados: se confirmó la presencia de anticuerpos contra el virus linfotrópico de células T humano tipo I en el suero. Se observó un incremento del número de células positivas por inmunofluorescencia indirecta en el monitoreo secuencial y se detectó la presencia de ADN proviral en las células mononucleares de sangre periférica. Conclusiones: los resultados evidenciaron el aislamiento del virus y corroboraron, por primera vez en Cuba, la asociación entre el virus linfotrópico de células T humano tipo I y paraparesia espástica tropical.

Background: Tropical spastic paraparesis or HTLV-I-associated myelopathy (TSP/HAM) is a chronic neurological disease etiologically linked to human T-cell lymphotropic virus type I (HTLV-I). Objective: to serologically confirm infection by and isolation of HTLV-I from the peripheral blood mononuclear cells from a patient who presented with a clinical picture similar to that of tropical spastic paraparesis. Methods: peripheral blood mononuclear cells were co-cultured for 35 days. Viral detection by membrane- specific immunofluorescence and polymerase chain reaction of genes tax, pol and gag were performed. Results: The presence of antibody to human T cell lymphotropic virus type I in serum was confirmed. Indirect immunofluorescence in the sequential monitoring made it possible to observe an increase of the number of positive cells whereas proviral DNA was detected in the peripheral blood mononuclear cells. Conclusions: these results support the evidence of viral isolation and confirmed, for first time in Cuba, the association between HTLV-I and TSP.

Seroprevalence of sexually transmitted infections among accepted and deferred blood donors in Jamaica / Seroprevalencia de las infecciones transmitidas sexualmente entre los donantes de sangre aceptados y diferidos en Jamaica

Critical donor selection and testing increases the safety of blood transfusion by excluding donors at risk of transmitting infections. This study investigated the seroprevalence of and risk factors for sexually transmitted infections (STIs) among accepted and deferred blood donors in Jamaica. A total of 1015 blood donors consisting of 794 (78) accepted donors and 221 (22) deferred donors presenting at the Central Blood Bank, Jamaica, over a six-month period, were recruited for this study. A standardized questionnaire was administered to each participant and a sample of blood obtained for detection of hepatitis B surface antigen, antibodies to Treponema pallidum, human immunodeficiency virus (HIV) and human T-cell lymphotrophic virus type-1 (HTLV-1). Deferred donors were three times more likely to be seropositive for STI than accepted donors (16.3vs 5.2, OR 3.57, 95CI 2.16 - 5.90, p < 0.0001). Males had significant association between STI seropositivity and having fathered children with two or more women (p = 0.0085), unprotected sexual intercourse with several persons (p = 0.0326), and history of genital herpes (p = 0.0121). Significant risk factors identified among females were unprotected sex with several partners (p = 0.0385); having more than ten lifetime partners (p = 0.0105); and use of depoprovera (p = 0.0028). This study confirms higher rates of STI among deferred blood donors and supports the donor deferral system in Jamaica.

La prueba y selección crítica del donante aumenta la seguridad de la transfusión de sangre, excluyendo a los donantes con riesgo de transmitir infecciones. Este estudio investigó la seroprevalencia de las infecciones transmitidas sexualmente (ITS) entre los donantes de sangre aceptados y diferidos en Jamaica. Un total de 1015 donantes de sangre consistente en 794 (78%) donantes aceptados, y 221 (22%) donantes diferidos que acudieron al Banco de Sangre Central en Jamaica por un periodo de seis meses, fueron reclutados para este estudio. A cada uno de los participantes se le aplicó una encuesta estandarizada, y se obtuvo una muestra de sangre para la detección del antígeno de superficie de la hepatitis B, los anticuerpos del Treponema pallidum, el virus de la inmunodeficiencia humana (VIH), y el virus linfotrópico humano de células T tipo 1 (HTLV-1). Los donantes diferidos presentaron una probabilidad tres veces mayor de ser seropositivos que los donantes aceptados (16.3% frente a 5.2%, OR 3.57, 95% CI 2.16 - 5.90, p <0.0001). En los varones se dio una asociación significativa entre la seropositividad de ITS y el haber engendrado hijos con dos o más mujeres (p = 0.0085), el intercambio sexual desprotegido con distintas personas (p = 0.0326), y una historia de herpes genitales (p = 0.0121). Los factores de riesgo significativos identificados entre las hembras fueron el sexo desprotegido con diferentes parejas (p = 0.0385), el haber tenido más de diez parejas a lo largo de su vida (p = 0.0105), y el uso de depoprovera (p = 0.0028). Este estudio confirma que las tasas de ITS entre los dotantes de sangre diferidos son más altas, y respalda el sistema de aplazamiento de donantes en Jamaica.

Seropositividad al virus linfotrópico de células T humanas tipos I y II en donantes del Banco Municipal de Sangre de Caracas y factores de riesgo asociados / Seropositivity for human T-lymphotropic virus types I and II among donors at the Municipal Blood Bank of Caracas and associated risk factors

OBJETIVOS: Conocer la proporción de sangre descartada por seropositividad al virus linfotrópico de células T humanas (HTLV) tipos I y II, la prevalencia de dicha infección y los probables factores de riesgo en donantes del Banco Municipal de Sangre de Caracas (BMSC). MÉTODOS: Se evaluaron serológicamente mediante ensayos de inmunoadsorción enzimática (ELISA) 23 413 donantes atendidos entre julio del año 2000 y abril de 2001 en el BMSC. Las muestras repetidamente reactivas (RR) se estudiaron por inmunoblot de Western (WB), como prueba suplementaria. Los donantes positivos o indeterminados por WB fueron citados a la consejería para realizar la confirmación mediante la amplificación de ácidos nucleicos por reacción en cadena de la polimerasa (PCR), recoger datos sobre sus antecedentes de riesgo y asesorarlos acerca de su estado. RESULTADOS. El 0,2 por ciento de las donaciones resultaron RR; de ellas 52,1 por ciento resultaron positivas en el WB (23 a HTLV I y 2 a HTLV II); 4,1 por ciento indeterminadas por WB; 29,2 por ciento negativas; y el 14,6 por ciento no pudo ser evaluado. Asistieron a la consejería 16 donantes (14 WB positivos a HTLV I, 1 a HTLV II y 1 indeterminado). Todos resultaron positivos en la RCP. No se encontraron diferencias significativas con el grupo control en cuanto a edad, sexo, tipo de donación, número de donaciones previas, antecedentes de transfusiones y comportamiento sexual. Se observaron diferencias significativas según los antecedentes de consumo de drogas no intravenosas (P < 0,05), y altamente significativas (P < 0,001) según los antecedentes de lactancia materna larga. Las madres estudiadas de seis de los donantes positivos que manifestaron haber tenido una larga lactancia materna resultaron positivas, al igual que el hijo mayor de la única pareja positiva de las 13 evaluadas. CONCLUSIONES. Se descartó el 0,2 por ciento de la sangre por resultar positiva al HTLV I/II. La prevalencia entre los donantes fue de 0,11 por ciento. En el 37,5 por ciento de los casos se pudo determinar la probabilidad de transmisión de madre a hijo. La transmisión sexual resultó menos frecuente. Se debe considerar seriamente la implementación del tamizaje serológico del HTLV I/II en los donantes de sangre de Venezuela

Demencia subcortical en paraparesia espástica tropical asociada a HTLV-I: estudio de 43 casos / Subcortical dementia in HTLV-I tropical spastic paraparesis: study of 43 cases

Background: Central nervous system damage associated to HTLV-I does not limit itself to the spinal cord, but also involves subcortical structures, producing cognitive impairment and behavioral changes which eventually could conform a new form of subcortical dementia. Aim: To study cognitive changes in patients with HTLV-I associated myelopathy. Patients and methods: Forty three patients (31 female) with Tropical Spastic Paraparesis, aged 52 years old as a mean and with a disease lasting a mean of 7.5 years, were studied. The diagnosis was based on clinical, radiological and neurophysiological changes. The virus was identified with ELISA, indirect immunofluorecence, Western Blot or proviral DNA identification. Cognitive assessment was done using the Wechler Adult Intelligence Scale (WAIS) and Benton Visual Retention Test (form D). Patients were grouped according to their motor disability in; 23 patients with independent spastic gait, 11 patients that needed support to walk and 9 patients unable to walk. Results: WAIS test demonstrated cognitive impairment with special deficit in some subtests such as Digit Span, Digit Symbol, Picture Arrangement and Object Assembly. Benton Test also disclosed cognitive impairment. There was a positive relationship between cognitive and motor performance. Conclusions: At least 50 percent of patients with Tropical Spastic Paraparesis have certain degree of intellectual and affective impairment