ABSTRACT
Infection with human T-cell lymphotrophic virus-I (HTLV-I) is now a global epidemic, affecting 10 to 20 million people. This virus has been linked to life-threatening, incurable diseases, adult T-cell leukemia/lymphoma (ATLL), and HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP), as well as several chronic illnesses, such as uveitis and dermatitis. The cumulative lifetime risk of developing these incurable diseases is approximately 5% in asymptomatic patients. For operating room personnel performing surgery among patients from high-risk groups, HTLV-I and its associated diseases are presenting an increasing challenge. This report describes its transmission, seroprevalence, treatment, and public health initiatives that must be instituted to prevent the spread of this retrovirus. Coinfection with HTLV-I and human immunodeficiency virus (HIV) has been shown to accelerate the progression of acquired immune deficiency syndrome (AIDS).
Subject(s)
Epidemics , HTLV-I Infections/epidemiology , Human T-lymphotropic virus 1 , Dermatitis/virology , Global Health , HTLV-I Infections/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Leukemia-Lymphoma, Adult T-Cell/virology , Occupational Diseases/prevention & control , Occupational Diseases/virology , Paraparesis, Tropical Spastic/virology , Public Health , Seroepidemiologic Studies , Uveitis/virologyABSTRACT
Cardiovascular complications are infrequent but can result in significant morbidity following noncardiac surgery, especially in patients with peripheral vascular disease or increased age. All patients require some level of preoperative screening to identify and minimize immediate and future risk, with a careful focus on known coronary artery disease or risks for coronary artery disease and functional capacity. The 2007 American College of Cardiology/American Heart Association Guidelines are clear that noninvasive and invasive testing should be limited to circumstances in which results will clearly affect patient management or in which testing would otherwise be indicated. beta-Blocker therapy has become controversial in light of recent publications but should be continued in patients already on therapy, and started in patients with high cardiac risk undergoing intermediate- or high-risk surgery.
Subject(s)
Cardiovascular Diseases/diagnosis , Perioperative Care/standards , Preoperative Care/standards , Surgical Procedures, Operative/adverse effects , Adrenergic beta-Antagonists/therapeutic use , Cardiovascular Diseases/complications , Comorbidity , Diagnostic Tests, Routine , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Patient Care Planning/standards , Postoperative Complications/prevention & control , Practice Guidelines as Topic , Predictive Value of Tests , Prognosis , Risk Assessment , Risk Factors , United StatesABSTRACT
Infection with human T-cell lymphotrophic virus-I (HTLV-I) is now a global epidemic, affecting 10 to 20 million people. This virus has been linked to life-threatening, incurable diseases, adult T-cell leukemia/lymphoma (ATLL), and HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP), as well as several chronic illnesses, such as uveitis and dermatitis. The cumulative lifetime risk of developing these incurable diseases is approximately 5% in asymptomatic patients. For operating room personnel performing surgery among patients from high-risk groups, HTLV-I and its associated diseases are presenting an increasing challenge. This report describes its transmission, seroprevalence, treatment, and public health initiatives that must be instituted to prevent the spread of this retrovirus. Coinfection with HTLV-I and human immunodeficiency virus (HIV) has been shown to accelerate the progression of acquired immune deficiency syndrome (AIDS).
