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Rathsam-Pinheiro RH, Boa-Sorte N, Grassi MFR, Copello ÚC, Rios KTSG, Araújo T, Galvão-Castro B. Revisiting Keratoconjunctivitis sicca associated with Human T-Cell Lymphotropic Virus Type 1: prevalence, clinical aspects and proviral load. Braz J Infect Dis 2019; 23:95-101. [PMID: 31059675 PMCID: PMC9425656 DOI: 10.1016/j.bjid.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background The prevalence of keratoconjunctivitis sicca (KCS) associated with Human T-Cell Lymphotropic Virus Type 1 (HTLV-1) (HTLV-1/KCS) has been estimated at around 37%, but its clinical manifestations are poorly described. Purpose To determine the prevalence and associated factors of HTLV-1/KCS in a large cohort of HTLV-1-infected individuals living in Salvador, Brazil. Methods A cross-sectional study was conducted between June 2004 and September 2017 at the Integrative and Multidisciplinary Center for HTLV in Salvador, Bahia-Brazil. Data from 758 HTLV-1-infected patients was collected. A complete ophthalmologic examination was performed in both eyes. Lacrimal function was evaluated by breakup time, Rose Bengal and Schirmer I Tests. KCS diagnosis was considered in the presence of at least two out of three positive tests. HTLV-1 proviral load Crude and Adjusted Prevalence Rates (PR) with 95% Confidence Intervals (95% CI) were estimated using multivariate Poisson Regression with robust error variance. Results The overall prevalence of KCS was 31.7%, with higher rates observed in HTLV-1-associated myelopathy/tropical spastic paraparesis patients (crude PR: 1.84; CI95%: 1.50–2.26) even after adjusting for age, sex, time of HTLV-1 diagnosis and schooling (adjusted PR: 1.63; CI95%: 1.31–2.02). Proviral load, low corrected visual acuity, burning and/or pain and itching were all significantly higher in patients with KCS. Conclusion Burning and/or pain and itching and low corrected visual acuity were the most common alterations of HTLV-1/KCS. High Proviral load was found to be associated with the presence of KCS. It is strongly recommended that HTLV-1 patients undergo periodic ophthalmologic examination to promote the early diagnosis of KCS and prevent the consequences associated with dry eye disease.
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Affiliation(s)
- Regina Helena Rathsam-Pinheiro
- Escola Bahiana de Medicina e Saúde Pública, Centro Integrativo e Interdisciplinar de HTLV, Salvador, BA, Brazil; Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira, Salvador, BA, Brazil
| | - Ney Boa-Sorte
- Escola Bahiana de Medicina e Saúde Pública, Centro Integrativo e Interdisciplinar de HTLV, Salvador, BA, Brazil
| | - Maria Fernanda Rios Grassi
- Escola Bahiana de Medicina e Saúde Pública, Centro Integrativo e Interdisciplinar de HTLV, Salvador, BA, Brazil; Fundação Oswaldo Cruz/Bahia, Instituto Gonçalo Moniz, Salvador, BA, Brazil
| | - Úrsula Cury Copello
- Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira, Salvador, BA, Brazil
| | | | - Thessika Araújo
- Escola Bahiana de Medicina e Saúde Pública, Centro Integrativo e Interdisciplinar de HTLV, Salvador, BA, Brazil
| | - Bernardo Galvão-Castro
- Escola Bahiana de Medicina e Saúde Pública, Centro Integrativo e Interdisciplinar de HTLV, Salvador, BA, Brazil; Fundação Oswaldo Cruz/Bahia, Instituto Gonçalo Moniz, Salvador, BA, Brazil.
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Evaluation of the cervicovaginal environment in asymptomatic Human T-cell lymphotropic virus type 1 infected women. Braz J Infect Dis 2019; 23:27-33. [PMID: 30849331 PMCID: PMC9428004 DOI: 10.1016/j.bjid.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 11/20/2022] Open
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.
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Ahmadi Ghezeldasht S, Hedayati-Moghaddam MR, Habibi M, Mollahosseini F, Rafatpanah H, Miri R, Hatef Fard M, Sahebari M. Rate of positive autoimmune markers in Human T lymphotropic virus type 1 carriers: a case-control study from Iran. Int J Rheum Dis 2017; 21:108-113. [PMID: 28261958 DOI: 10.1111/1756-185x.13002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Human T lymphotropic virus type 1 (HTLV-1) infection with high prevalence in the north-east of Iran, particularly in Mashhad, can lead to adult T-cell leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and a variety of autoimmune diseases. The aim of the study was to examine the presence of autoimmune markers in HTLV carries. METHODS Serum samples were obtained from blood donors in Mashhad, northeastern Iran. One hundred and five HTLV-1 positive (cases) and 104 age- and sex-matched HTLV-1 negative donors (controls) were assessed for presence of serum autoimmune markers by enzyme-linked immunosorbent assay. RESULTS The mean ages of cases and controls were 40.8 ± 9.4 and 41.5 ± 9.3 years, respectively (P = 0.5). In the case group, 81.9% and in the control group 83.7% were male (P = 0.74). The frequency of positive antinuclear antibodies and anticyclic citrullinated peptide antibodies in the serum of the two groups were not significantly different (P = 0.68 and P = 0.62, respectively). Only one antineutrophil cytoplasmic antibody-positive case (1%) was observed in the group and no anti-phospholipid immunoglobulin G positivity was observed. The frequency of rheumatoid factor (RF) was greater in case group than in the control group, although the difference was not significant (P = 0.08). The amount of RF in all 12 RF positive sera were higher than normal levels (33-37 IU/mL). CONCLUSION Because we failed to detect any significant relation between serum autoimmune markers and HTLV-1 infection, and because of the relatively low prevalence of autoimmune diseases, it could be concluded that healthy HTLV-1 carriers do not produce rheumatologic-related auto-antibodies more than the healthy population.
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Affiliation(s)
- Sanaz Ahmadi Ghezeldasht
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan, Mashhad, Iran
| | - Mohammad Reza Hedayati-Moghaddam
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan, Mashhad, Iran
| | - Meysam Habibi
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan, Mashhad, Iran.,Rheumatic Diseases Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Mollahosseini
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine and Razavi Khorasan Blood Transfusion Center, Tehran, Iran
| | - Houshang Rafatpanah
- Inflammation and Inflammatory Diseases Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rahele Miri
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan, Mashhad, Iran
| | - MohammadReza Hatef Fard
- Rheumatic Diseases Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- Rheumatic Diseases Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Santos RFS, Conceição GC, Martins MS, Kraychete A, Penalva MAC, Carvalho EM, Lopes AA, Rocha PN. Prevalence and risk factors for Human T-Lymphotropic Virus Type 1 (HTLV-1) among maintenance hemodialysis patients. BMC Nephrol 2017; 18:64. [PMID: 28202003 PMCID: PMC5312583 DOI: 10.1186/s12882-017-0484-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/09/2017] [Indexed: 11/11/2022] Open
Abstract
Background Infection with the human T-cell lymphotropic virus type 1 (HTLV-1), although asymptomatic in most cases, can lead to potentially grave consequences, such as adult T-cell leukemia-lymphoma and HTLV-1-associated myelopathy / tropical spastic paraparesis. Its prevalence varies widely across different populations and geographic regions. A population-based study in the city of Salvador, located in the Northeast region of Brazil, showed an overall prevalence of HTLV-1 seropositivity of 1.7%. Blood borne virus infections are recognized as important hazards for patients and staff in maintenance hemodialysis (MHD) units but most studies focus on hepatitis B, hepatitis C and human immunodeficiency viruses. There are scarce data about HTLV-1 infection in the MHD population. We aimed to determine the prevalence and risk factors for HTLV-1 infection among MHD patients in the city of Salvador-Bahia, Brazil. Methods We conducted a multi-center, cross-sectional study nested in a prospective cohort of MHD patients enrolled from four outpatient clinics. HTLV-1 screening was performed with ELISA and positive cases were confirmed by Western Blot. Factors associated with HTLV-1 seropositivity were identified by multivariable logistic regression. Results 605 patients were included in the study. The overall prevalence of HTLV-1 infection was 2.48% (15/605), which was similar to that of hepatitis B [1.98% (12/605)] and C [3.14% (19/605)] viruses in our sample. HTLV-1 seropositivity was positively associated with age [prevalence odds ratio (POR) 1.04; 95% confidence interval (CI) 1.01–1.08], unmarried status (POR 3.65; 95% CI 1.13–11.65), and history of blood transfusion (POR 3.35; 95% CI 1.01–11.13). Conclusions The overall prevalence of HTLV-1 infection in a sample of MHD patients was similar to that of other viral infections, such as hepatitis B and C. Our data revealed that MHD patients who are older, unmarried or who have received blood transfusions are at higher risk for HTLV-1 infection.
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Affiliation(s)
- Rilma F S Santos
- Division of Nephrology, Hospital Geral Roberto Santos, Salvador, Brazil. .,Postgraduate Program in Health Sciences, Federal University of Bahia, Salvador, Brazil.
| | | | - Márcia S Martins
- Unit of Clinical Epidemiology and Evidence Based Medicine of the Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Angiolina Kraychete
- Unit of Clinical Epidemiology and Evidence Based Medicine of the Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | | | - Edgar M Carvalho
- Centro de Pesquisas Gonçalo Moniz (Fiocruz-Ba), Salvador, Brazil.,Department of Internal Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Antonio Alberto Lopes
- Unit of Clinical Epidemiology and Evidence Based Medicine of the Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil.,Department of Internal Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Paulo Novis Rocha
- Postgraduate Program in Health Sciences, Federal University of Bahia, Salvador, Brazil.,Department of Internal Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
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Vale DAD, Casseb J, de Oliveira ACP, Bussoloti Filho I, de Sousa SCOM, Ortega KL. Prevalence of Sjögren's syndrome in Brazilian patients infected with human T-cell lymphotropic virus. J Oral Pathol Med 2016; 46:543-548. [PMID: 27925697 DOI: 10.1111/jop.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Human T-lymphotropic virus type I (HTLV-I) is known to be associated with neoplastic and neurodegenerative changes, and it is believed to be associated with various systemic inflammatory diseases, including Sjögren's syndrome (SS). Although HTLV-I infection is endemic in Brazil, there is no information regarding the association between HTLV-I infection and SS in the Brazilian population. The objective of this study was to determine the prevalence of SS in HTLV-I-infected individuals and the prevalence of HTLV-I infection in individuals diagnosed with SS. METHODS Serology for HTLV-I was performed in 50 patients presenting with complaints consistent with SS (the SS group). The HTLV-I group comprised 129 HTLV-I-infected patients who were screened for SS. RESULTS None of the patients in the SS group tested positive for HTLV-I. Of the 129 patients in the HTLV-I group, 46 (35.7%) had xerostomia, 18 (13.95%) had xerophthalmia, eight (6.2%) had hyposalivation, two (1.55%) showed impaired tear secretion, and one (0.77%) was positive for autoantibodies (anti-SSB). In addition, six underwent minor salivary gland biopsy, and the histopathological findings were consistent with SS. Only two (1.55%) met the diagnostic criteria for SS. CONCLUSIONS The prevalence of SS was found to be three times as high in HTLV-I-infected individuals as it was in those without HTLV-I infection. However, given the small number of HTLV-seropositive patients with SS, it is impossible to state that HTLV acts as an immune-activating pathogen for SS.
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Affiliation(s)
- Daniela Assis do Vale
- Special Care Dentistry Center, Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - Jorge Casseb
- Institute of Tropical Medicine of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Ivo Bussoloti Filho
- Department of Otorhinolaryngology, Irmandade da Santa Casa de Misericordia, Sao Paulo, Brazil
| | | | - Karem López Ortega
- Special Care Dentistry Center, Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
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Association of Sicca Syndrome with Proviral Load and Proinflammatory Cytokines in HTLV-1 Infection. J Immunol Res 2016; 2016:8402059. [PMID: 26904697 PMCID: PMC4745379 DOI: 10.1155/2016/8402059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/14/2015] [Accepted: 12/29/2015] [Indexed: 12/01/2022] Open
Abstract
The Sjögren syndrome has been diagnosed in patients with HTLV-1 associated myelopathy and dry mouth and dry eyes are documented in HTLV-1 carriers. However the diagnosis of Sjögren syndrome in these subjects has been contested. In this cross-sectional study, we evaluated the role of immunological factors and proviral load, in sicca syndrome associated with HTLV-1 in patients without myelopathy. Subjects were recruited in the HTLV-1 Clinic, from 2009 to 2011. The proviral load and cytokine levels (IFN-γ, TNF-α, IL-5, and IL-10) were obtained from a database containing the values presented by the subjects at admission in the clinic. Of the 272 participants, 59 (21.7%) had sicca syndrome and in all of them anti-Sjögren syndrome related antigen A (SSA) and antigen B (SSB) were negatives. The production of TNF-α and IFN-γ was higher in the group with sicca syndrome (P < 0.05) than in HTLV-1 infected subjects without sicca syndrome. Our data indicates that patients with sicca syndrome associated with HTLV-1 do not have Sjögren syndrome. However the increased production of TNF-α and IFN-γ in this group of patients may contribute to the pathogenesis of sicca syndrome associated with HTLV-1.
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Souza A, Tanajura D, Toledo-Cornell C, Santos S, Carvalho EMD. Immunopathogenesis and neurological manifestations associated to HTLV-1 infection. Rev Soc Bras Med Trop 2013; 45:545-52. [PMID: 23152334 DOI: 10.1590/s0037-86822012000500002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 09/14/2012] [Indexed: 12/14/2022] Open
Abstract
The human T lymphotropic virus type-1 (HTLV-1) was the first human retrovirus identified. The virus is transmitted through sexual intercourse, blood transfusion, sharing of contaminated needles or syringes and from mother to child, mainly through breastfeeding. In addition to the well-known association between HTLV-1 and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), several diseases and neurologic manifestations have been associated with the virus. This review was conducted through a PubMed search of the terms HTLV-1, immune response and neurological diseases. Emphasis was given to the most recent data regarding pathogenesis and clinical manifestations of HTLV-1 infection. The aim of the review is to analyze the immune response and the variety of neurological manifestations associated to HTLV-1 infection. A total of 102 articles were reviewed. The literature shows that a large percentage of HTLV-1 infected individuals have others neurological symptoms than HAM/TSP. Increased understanding of these numerous others clinical manifestations associated to the virus than adult T cell leukemia/lymphoma (ATLL) and HAM/TSP has challenged the view that HTLV-1 is a low morbidity infection.
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Affiliation(s)
- Anselmo Souza
- Serviço de Imunologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
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Lins L, de Carvalho VJU, de Almeida Rego FF, Azevedo R, Kashima S, Gallazi VNO, Xavier MT, Galvão-Castro B, Alcantara LCJ. Oral health profile in patients infected with HTLV-1: Clinical findings, proviral load, and molecular analysis from HTLV-1 in saliva. J Med Virol 2012; 84:1428-36. [DOI: 10.1002/jmv.23327] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Keratoconjunctivitis sicca of human T cell lymphotropic virus type 1 (HTLV-1) infected individuals is associated with high levels of HTLV-1 proviral load. J Clin Virol 2011; 52:177-80. [DOI: 10.1016/j.jcv.2011.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/15/2011] [Accepted: 07/20/2011] [Indexed: 11/22/2022]
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Clinical manifestations in individuals with recent diagnosis of HTLV type I infection. J Clin Virol 2011; 51:54-8. [PMID: 21388871 DOI: 10.1016/j.jcv.2011.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 01/07/2011] [Accepted: 02/07/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Human T-lymphotropic virus type 1 (HTLV-1) is known to cause HTLV-associated myelopathy (HAM)/tropical spastic paraparesis and adult T cell leukemia. A growing body of evidence links HTLV-1 infection with an increasing spectrum of disease, including uveitis, periodontal disease, arthropathy, sicca syndrome, and neurologic deficits. OBJECTIVES Despite recent findings, the natural history of HTLV-1 infection remains poorly defined. This study was designed to better characterize initial clinical and neurological findings in individuals diagnosed with HTLV-1 infection. STUDY DESIGN We conducted a cross-sectional study of 71 individuals recently diagnosed with HTLV-1 and 71 uninfected age- and sex-matched blood donors in Salvador, Brazil. Subjects were administered a standardized questionnaire and underwent physical exam. RESULTS HTLV-1 infected subjects were significantly more likely than controls to report complaints of hand and foot numbness (OR=5.3; 95% CI: 1.8-15.3; p=0.002 and OR=4.0; 95% CI: 1.3-12; p=0.013 respectively), difficulty running (OR=4.0; 95% CI: 1.1-14.2; p=0.032), nocturia (OR=5.0; 95% CI: 1.1-22.8; p=0.038), arthralgia (OR=3.3; 95% CI: 1.4-7.7; p=0.006), and photophobia (OR=3.3; 95% CI: 1.4-7.7; p=0.006). CONCLUSIONS Neurologic, ocular and rheumatologic complaints may be the first manifestations of HTLV-1 infection. Therefore, all patients presenting with initial diagnosis should be rigorously screened for these symptoms.
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