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Roc L, de Mendoza C, Fernández-Alonso M, Reina G, Soriano V. Rapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals. Ther Adv Infect Dis 2019; 6:2049936119868028. [PMID: 31467675 PMCID: PMC6704407 DOI: 10.1177/2049936119868028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/16/2019] [Indexed: 12/28/2022] Open
Abstract
Two kidney transplant recipients from a single donor became infected with HTLV-1 (human T-lymphotropic virus type 1) in Spain. One developed myelopathy 8 months following surgery despite early prescription of antiretroviral therapy. The allograft was removed from the second recipient at month 8 due to rejection and immunosuppressors discontinued. To date, 3 years later, this patient remains infected but asymptomatic. HTLV-1 infection was recognized retrospectively in the donor, a native Spaniard who had sex partners from endemic regions. Our findings call for a reappraisal of screening policies on donor–recipient organ transplantation. Based on the high risk of disease development and the large flux of persons from HTLV-1 endemic regions, pre-transplant HTLV-1 testing should be mandatory in Spain.
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Affiliation(s)
- Lourdes Roc
- Microbiology Department, Hospital Miguel Servet, Zaragoza
| | - Carmen de Mendoza
- Puerta de Hierro Research Institute and University Hospital, Majadahonda, Madrid, Spain
| | | | - Gabriel Reina
- Microbiology Department, Clinica Universitaria, Pamplona
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de Mendoza C, Roc L, Benito R, Reina G, Ramos JM, Gómez C, Aguilera A, Rodríguez-Iglesias M, García-Costa J, Fernández-Alonso M, Soriano V. HTLV-1 infection in solid organ transplant donors and recipients in Spain. BMC Infect Dis 2019; 19:706. [PMID: 31399112 PMCID: PMC6688206 DOI: 10.1186/s12879-019-4346-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/31/2019] [Indexed: 11/22/2022] Open
Abstract
Background HTLV-1 infection is a neglected disease, despite infecting 10–15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. Methods All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. Results A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. Conclusion The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy.
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Affiliation(s)
- Carmen de Mendoza
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.,Universidad CEU-San Pablo, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Vicente Soriano
- UNIR Health Sciences School and Medical Centre, Calle Almansa 101, 28040, Madrid, Spain.
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Razonable RR. Not the Usual Viral Suspects: Parvovirus B19, West Nile Virus, and Human T-Cell Lymphotrophic Virus Infections After Kidney Transplantation. Semin Nephrol 2018; 36:428-434. [PMID: 27772627 DOI: 10.1016/j.semnephrol.2016.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kidney transplant recipients are at increased risk of developing clinical disease due to uncommon opportunistic viral pathogens. Refractory anemia is classically associated with parvovirus B19 infection. West Nile virus has the propensity to cause fever and neurologic symptoms, while spastic paresis and lymphoma can be triggered by human T cell lymphotrophic virus. In this review article, the epidemiology, clinical manifestations, diagnosis and treatment of less common viruses are discussed in the setting of kidney transplantation.
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Affiliation(s)
- Raymund R Razonable
- Division of Infectious Diseases and the William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
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4
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Abstract
: Human T-lymphotropic virus type 1 (HTLV-1) infection is a neglected disease despite roughly 15 million people are chronically infected worldwide. Lifelong less than 10% of carriers develop life-threatening diseases, mostly a subacute myelopathy known as tropical spastic paraparesis (TSP) and a lymphoproliferative disorder named adult T-cell leukemia (ATL). HTLV-1 is efficiently transmitted perinatally (breastfeeding), sexually (more from men to women) and parenterally (transfusions, injection drug user (IDU), and transplants). To date there is neither prophylactic vaccine nor effective antiviral therapy. A total of 327 cases of HTLV-1 infection had been reported at the HTLV-1 Spanish registry until December 2016, of whom 34 had been diagnosed with TSP and 25 with ATL. Overall 62% were Latin American immigrants and 13% were persons of African origin. The incidence of HTLV-1 in Spain has remained stable for nearly a decade with 20-25 new cases yearly. Of the 21 newly diagnosed HTLV-1 cases during year 2016, one was a native Spaniard pregnant woman, and four presented with symptomatic disease, including three with ATL and one with TSP. Underdiagnosis of HTLV-1 in Spain must be high (iceberg model), which may account for the disproportionate high rate of symptomatic cases (almost 20%) and the late recognition of preventable HTLV-1 transmissions in special populations, such as newborns and transplant recipients. Our current estimate is of 10 000 persons living with HTLV-1 infection in Spain. Given the large flux of immigrants and visitors from HTLV-1 endemic regions to Spain, the expansion of HTLV-1 screening policies is warranted. At this time, it seems worth recommending HTLV testing to all donor/recipient organ transplants and pregnant women regardless place of birth. Although current leukoreduction procedures largely prevent HTLV-1 transmission by blood transfusions, HTLV testing of all first-time donors should be cost-effective contributing to unveil asymptomatic unaware HTLV-1 carriers.
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Abstract
Medical science is just now realizing the full importance of the microbial world. Thanks to developments such as low-cost high-throughput sequencing of microbial communities comprising the human microbiome, the identity and function of unculturable microbes are being unveiled. Public health officials and neuroepidemiology researchers will be called on to guide the understanding of I-Cubed illnesses and the implications of the human microbiome for communicable and noncommunicable diseases, as the natural history is appreciated and the responsiveness of given medical and neurologic disorders to a variety of medical approaches, including strong antibiotics and immune-modulatory therapy is established.
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Affiliation(s)
- David S Younger
- Division of Neuroepidemiology, Department of Neurology, New York University School of Medicine, New York, NY, USA; College of Global Public Health, New York University, New York, NY, USA.
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Cook LBM, Melamed A, Demontis MA, Laydon DJ, Fox JM, Tosswill JHC, de Freitas D, Price AD, Medcalf JF, Martin F, Neuberger JM, Bangham CRM, Taylor GP. Rapid dissemination of human T-lymphotropic virus type 1 during primary infection in transplant recipients. Retrovirology 2016; 13:3. [PMID: 26745892 PMCID: PMC4706667 DOI: 10.1186/s12977-015-0236-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/22/2015] [Indexed: 11/24/2022] Open
Abstract
Background Human T-lymphotropic virus type 1 (HTLV-1) infects an estimated 10 million persons globally with transmission resulting in lifelong infection. Disease, linked to high proviral load, occurs in a minority. In established infection HTLV-1 replicates through infectious spread and clonal expansion of infected lymphocytes. Little is known about acute HTLV-1 infection. The kinetics of early HTLV-1 infection, following transplantation-acquired infection in three recipients from one HTLV-1 infected donor, is reported. The recipients were treated with two HTLV-1 enzyme inhibitors 3 weeks post exposure following the detection of HTLV-1 provirus at low level in each recipient. HTLV-1 infection was serially monitored by serology, quantification of proviral load and HTLV-1 2LTR DNA circles and by HTLV-1 unique integration site analysis. Results HTLV-1 antibodies were first detected 16–39 days post-transplantation. HTLV-1 provirus was detected by PCR on day 16–23 and increased by 2–3 log by day 38–45 with a peak proviral doubling time of 1.4 days, after which
steady state was reached. The rapid proviral load expansion was associated with high frequency of HTLV-1 2LTR DNA circles. The number of HTLV-1 unique integration sites was high compared with established HTLV-1 infection. Clonal expansion of infected cells was detected as early as day 37 with high initial oligoclonality index, consistent with early mitotic proliferation. Conclusions In recipients infected through organ transplantation HTLV-1 disseminated rapidly despite early anti-HTLV-1 treatment. Proviral load set point was reached within 6 weeks. Seroconversion was not delayed. Unique integration site analysis and HTLV-1 2LTR DNA circles indicated early clonal expansion and high rate of infectious spread.
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Affiliation(s)
- Lucy B M Cook
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Anat Melamed
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Maria Antonietta Demontis
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Daniel J Laydon
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - James M Fox
- Department of Biology and Hull York Medical School, Centre for Immunology and Infection, University of York, York, UK.
| | | | - Declan de Freitas
- Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK.
| | - Ashley D Price
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
| | - James F Medcalf
- John Walls Renal Unit, Leicester General Hospital, Gwendolen Road, Leicester, UK.
| | - Fabiola Martin
- Department of Biology and Hull York Medical School, Centre for Immunology and Infection, University of York, York, UK.
| | - James M Neuberger
- Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, UK.
| | - Charles R M Bangham
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Graham P Taylor
- Section of Virology, Department of Medicine, Imperial College London, Norfolk Place, London, W2 1PG, UK.
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Gövert F, Krumbholz A, Witt K, Hopfner F, Feldkamp T, Korn K, Knöll A, Jansen O, Deuschl G, Fickenscher H. HTLV-1 associated myelopathy after renal transplantation. J Clin Virol 2015; 72:102-5. [DOI: 10.1016/j.jcv.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/25/2015] [Accepted: 09/25/2015] [Indexed: 11/16/2022]
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Ramanan P, Deziel PJ, Norby SM, Yao JD, Garza I, Razonable RR. Donor-derived HTLV-1 associated myelopathy after transplantation: a call for targeted screening. Am J Transplant 2015; 15:1125. [PMID: 25772487 DOI: 10.1111/ajt.13146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P Ramanan
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
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Postrenal Transplant Human T-Cell Lymphotropic Virus Type I-Associated Myelopathy/Tropical Spastic Paraparesis: A Case Report and Review of the Literature. Transplant Direct 2015; 1:e3. [PMID: 27500208 DOI: 10.1097/txd.0000000000000512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/06/2015] [Indexed: 11/26/2022] Open
Abstract
We report a case of human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), in a 59 year-old, living-donor, renal transplant recipient from Jamaica. The patient's renal transplant had been performed 11 years ago, and her organ donor was also from Jamaica. Pretransplant HTLV-I serologic status for both the donor and recipient was unknown. The prevalence of HTLV-I seropositivity in the United States and Europe is low, and HAM/TSP is a rare occurrence. The positive predictive value of HTLV-I screening in these regions is therefore, low. This has generated debate among transplant societies regarding universal screening for HTLV-I before solid organ transplantation. Very limited evidence is available for the prevention and treatment of this devastating condition. Our case highlights the importance of selected pretransplant screening for HTLV-I infection among organ donors and candidates from endemic areas. We feel such testing may aid in the early recognition of HAM/TSP and more timely initiation of treatment.
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