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High Expression of Inflammatory Cytokines and Chemokines in Human T-lymphotropic Virus 1-Associated Adult T-cell Leukemia/Lymphoma. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-132348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Human T-cell lymphotropic virus type 1 (HTLV-1) is the etiological agent of adult T-cell leukemia/lymphoma (ATLL) without any specific antiviral. Objectives: This study aimed to evaluate the expression level of inflammatory chemokines and pro-inflammatory cytokines in ATLL patients, asymptomatic carriers (ACs), and healthy individuals to assess the role of these inflammatory markers in ATLL pathogenicity. Methods: This study was conducted from May 2021 to August 2022. The ATLL blood samples were collected from the oncology wards of Imam Khomeini, Shariati, and Imam Hossein hospitals, in Tehran, Iran. The blood samples of ACs and normal control subjects were collected from blood donors referred to blood transfusion centers of Tehran and Alborz provinces, Iran. RNA extraction, complementary DNA (cDNA) synthesis, and real-time polymerase chain reaction (PCR) were done in targeted sample groups to investigate the correlation and expression rate of C-C motif chemokine ligand 3 (CCL3), C-C motif chemokine ligand 4 (CCL4), C-X-C motif chemokine ligand 8 (CXCL8), interleukin 23 subunit alpha (IL-23A), and interleukin 17 A (IL-17A). Results: A total of 30 samples were collected from 3 groups. The CCL3, CCL4, CXCL8, and IL-17A messenger RNA (mRNA) expression levels were significantly upregulated in the ATLL groups. There was a significant difference between CCL3 expression between the ACs and ATLL groups. In addition, CCL4 and CXCL8 expression levels were more significant in the ATLL group than in the normal control group. The IL-17A expression level significantly increased between groups. The IL-23A expression levels had no significant differences between the ATLL, ACs, and normal control groups. Conclusions: This study showed significant upregulation of pro-inflammatory cytokines and chemokines mRNAs in HTLV-1–associated ATLL compared to the ACs and normal control groups. Conducting more experiments to investigate the therapeutic effect of chemokines/cytokines in ATLL is essential.
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Ribeiro JF, Nobre AFS, Covre LCF, de Almeida Viana MDNDS, Silva IC, dos Santos LM, Ishikawa EA, da Costa CA, de Sousa MS. Hematological changes in human lymphotropic-T virus type 1 carriers. Front Microbiol 2022; 13:1003047. [DOI: 10.3389/fmicb.2022.1003047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
The human T-lymphotropic virus type 1 (HTLV-1), isolated in 1980, causes T-cell leukemia/lymphoma in adulthood, a type of lymphoproliferative disease, and chronic HTLV-1-associated myelopathy, a disease that causes paralysis of the lower limbs, which occur in about 5% of cases in this viral infection. This study aimed to establish the hematological profile of patients with HTLV-1 infection in Belém do Pará, describing the hematological parameters under study, estimating the frequency of lymphocytic atypical, and associating the hematological profile with diseases and symptoms. Hematologic data from 202 individuals were analyzed, including 87 HTLV-1 infected individuals and 115 non-HTLV-1 infected individuals as a control group, composed, at a great part, of relatives of the infected. The seroprevalence of HTLV-1 infection was observed in 71.3% of female individuals, with predominance in the group older than 50 years (44.8%). The analysis of hematological parameters showed a significant difference in the counts of the segmented cells (p = 0.0303) and eosinophils (p = 0.0092) in HTLV-1 carriers. Lymphocytic atypical was a finding present only in HTLV-1 carriers (p = 0.0001). There was no high frequency in the leukocyte counts of those infected by HTLV-1 not among them concerning a significant increase or decrease. It is concluded that HTLV-1 infection is prominent in women over 50 years old. The hematological profile of those infected shows a reduction of segmented cells, an increase of eosinophils, and the presence of atypical lymphocytes. The hematological profile of the HTLV-1 carrier should always be evaluated to identify early some diseases associated with the infection.
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Hashiba Y, Umekita K, Kimura M, Iwao C, Iwao K, Kariya Y, Kubo K, Miyauchi S, Kudou R, Rikitake Y, Kawaguchi T, Matsuda M, Takajo I, Inoue E, Hidaka T, Okayama A. High incidence of serious infections requiring hospitalisation in human T-cell leukaemia virus type 1-positive rheumatoid arthritis: A case-controlled observational study. Mod Rheumatol 2022; 32:866-874. [PMID: 34897491 DOI: 10.1093/mr/roab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We aimed to assess the clinical features of human T-cell leukaemia virus type 1 (HTLV-1)-positive rheumatoid arthritis (RA) patients. Furthermore, we investigated the impact of HTLV-1 infection on incidences of serious infections requiring hospitalisation (SIH) and malignancies. METHODS A total of 150 sex- and age-matched HTLV-1-negative and 50 HTLV-1-positive RA patients were enrolled from the HTLV-1 RA Miyazaki Cohort Study. Clinical and laboratory data were collected from this cohort database. The incidence rate (IR) for SIH and malignancies from 2015 to 2020 was analysed. RESULTS The median age and female ratio in the study population were 70 years old and 80%, respectively. Although no differences were found in inflammatory marker values between the two groups, the patient global assessment and Health Assessment Questionnaire scores were higher in HTLV-1-positive RA patients. In HTLV-1-negative RA patients, the IR for SIH was 6.37/100 person-years (PY) and 1.32/100 PY for malignancies. In HTLV-1-positive RA patients, SIH occurred in 11.1/100 PY and malignancies in 2.46/100 PY. The crude IR ratio comparing SIH between two groups was 1.74 (95% confidence interval, 1.04-2.84), which was a significant increase. CONCLUSIONS HTLV-1-positive RA patients may worsen RA symptoms. HTLV-1 may be a risk factor for SIH.
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Affiliation(s)
- Yayoi Hashiba
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Kunihiko Umekita
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masatoshi Kimura
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Chihiro Iwao
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kosho Iwao
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yumi Kariya
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazuyoshi Kubo
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Shunichi Miyauchi
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Risa Kudou
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuki Rikitake
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takeshi Kawaguchi
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Motohiro Matsuda
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ichiro Takajo
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Toshihiko Hidaka
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Akihiko Okayama
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
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da Silva Carvalho JM, de Araújo Campos EMT, Ferreira JLN, Carvalho HM, Carneiro Neto JA, de Oliveira Carneiro T, Carvalho EM. Radiographic aspects in individuals infected by human T-lymphotropic virus type 1 (HTLV-1) with joint pain. Adv Rheumatol 2022; 62:31. [DOI: 10.1186/s42358-022-00259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Joint pain in the absence or with little synovitis is observed in a large percentage of HTLV-1 infected subjects. As the virus infect CD4 + and CD8 + positive, macrophages and B cells an exaggerated production of pro-inflammatory cytokines is detected in these patients. However, the possible association of HTLV-1 infection with autoimmune diseases has not been documented definitively and the clinical characteristics of HTLV-1 associated arthropathy has not been defined. The objective this study is to describe clinic and radiographic features in HTLV-1-infected individuals with complaints of joint pain.
Methods
Cross-sectional study enrolling HTLV-1-infected individuals with chronic joint pain, aged up to 75 years, both genders and seronegative controls with osteoarthritis. All participants underwent conventional radiography of the hips, knees and ankles.
Results
Eighty-one HTLV-1 infected patients and 30 subjects with osteoarthritis participated in the study. Polyarticular and symmetrical arthritis prevailed in the HTLV-1 positive group (54%), while oligoarticular and asymmetrical (44%) were more common in controls (p < 0.05). The frequency of enthesophytes (90%) in HTLV-1-infected patients was greater than in the control group (73%) (p < 0.05). Radiographic features were similar in HTLV-1 carriers and in patients with probable or definite HTLV-1 associated myelopathy. The presence of enthesophytes in the absence of joint space reduction or osteophytes was only observed in HTLV-1-infected individuals (p < 0.001). Magnetic resonance imaging of the ankles of five HTLV-1-infected patients and five controls demonstrated a higher frequency of enthesitis, bursitis and osteitis in the HTLV-1 infected group.
Conclusion
HTLV-1-associated arthropathy is clinically characterized by symmetrical polyarthralgia and the main radiological finding is the presence of enthesophytes in the absence of osteophytes and joint space narrowing.
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Umekita K. Effect of HTLV-1 Infection on the Clinical Course of Patients with Rheumatoid Arthritis. Viruses 2022; 14:v14071460. [PMID: 35891440 PMCID: PMC9323945 DOI: 10.3390/v14071460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 02/06/2023] Open
Abstract
Human T-cell leukemia virus type 1 (HTLV-1) is the causative agent of adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The effects of HTLV-1 on health are not fully elucidated. Epidemiological studies have shown that the prevalence of HTLV-1 infection is high in patients with rheumatic diseases. The prevalence of comorbidities, such as Sjögren’s syndrome and rheumatoid arthritis (RA), is higher in patients with HAM/TSP than the in general population. Studies have shown the effects of HTLV-1-infection on the clinical course of RA. Major questions on the association between HTLV-1 infection and RA: (1) Is it possible that HTLV-1 infection causes RA? (2) Do patients with RA who are infected with HTLV-1 have different clinical features? (3) Are immunosuppressants associated with an increased prevalence of HAM/TSP or ATL in RA patients with HTLV-1 infection? Is ATL an immunosuppressive therapy-associated lymphoproliferative disorder? No large-scale studies have investigated the incidence of ATL in patients with RA. However, several studies have reported the development of ATL in patients with RA who have HTLV-1 infection. This review aimed to shed light on the association between HTLV-1 infection and RA and summarize the unmet medical needs of RA patients with HTLV-1 infection.
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Affiliation(s)
- Kunihiko Umekita
- Division of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
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Liberato de Matos SNF, Ladeia-Rocha G, Neto JAC, de Oliveira CJV, Neto CA, Passos L, Oliveira-Filho J, Carvalho EM. Diffusion tensor imaging metrics in diagnosis of
HTLV‐1‐associated
myelopathy. Ann Clin Transl Neurol 2022; 9:488-496. [PMID: 35263043 PMCID: PMC8994983 DOI: 10.1002/acn3.51521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sheila N F Liberato de Matos
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador.,UniFTC, Salvador, Bahia, Brazil
| | | | - José Abraão Carneiro Neto
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Cassius J V de Oliveira
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | | | - Lúcia Passos
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Jamary Oliveira-Filho
- Neurology Service, Professor Edgard Santos University Hospital, Salvador, Bahia, Brazil.,Instituto de Ciências da Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador.,Laboratório de Pesquisas Clínicas (LAPEC), Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil.,National Institute of Science and Technology in Tropical Diseases (INCT-DT), CNPq, Brazil
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Aben-Athar CYUP, Pinto DDS, Lima SS, Vallinoto IMVC, Ishak R, Vallinoto ACR. Limitations in daily activities, risk awareness, social participation, and pain in patients with HTLV-1 using the SALSA and Participation scales. Braz J Infect Dis 2020; 24:497-504. [PMID: 32941806 PMCID: PMC9392093 DOI: 10.1016/j.bjid.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background Tropical spastic paraparesis or HTLV-associated myelopathy (TSP/HAM) may prevent, limit or restrict the performance of daily living activities, and as a consequence, several aspects of life are affected. Objective The aim of this study was to evaluate activity limitations, risk awareness, social participation, quality of life, and pain in individuals infected with HTLV-1. Methods This was an observational, descriptive, analytical, cross-sectional study with a quantitative approach. An interview questionnaire, the Screening of Activity Limitation and Safety Awareness (SALSA) scale, the Participation scale, a quality of life questionnaire (SF-36) and the Brief Pain Inventory were used. Results A total of 55 patients with HTLV-1 were interviewed (62% asymptomatic and 38% symptomatic). In both groups, there was a higher frequency of patients aged 41–50 years old (35.3% asymptomatic and 38.1% symptomatic), with complete secondary education (47.1% asymptomatic and 42.9% symptomatic), and married (64.7% asymptomatic and 52.4% symptomatic). Of the symptomatic patients, 33.3% were retired; among asymptomatic patients, 20.6% performed domestic activities. The majority of patients in both groups had not received blood transfusions. Sexual intercourse was still practiced by patients. After assessment, asymptomatic patients had no activity limitations (64.7%), and symptomatic patients presented limitations (90.5%). None of the groups showed good risk awareness. There was no restriction on social participation in 97.1% of asymptomatic patients and in 52.4% among symptomatics. Both groups complained of pain, being more frequent in the lumbar spine in asymptomatic patients and in the knees in symptomatic patients. Pain was more severe in symptomatic patients and affected aspects of quality of life. Conclusion The clinical follow-up instruments must be adopted by healthcare professionals to monitor new symptoms so as to avoid the onset of limitations identified in symptomatic patients, in addition to enabling continuous surveillance of asymptomatic patients.
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Affiliation(s)
| | - Denise da Silva Pinto
- Universidade Federal do Pará, Instituto de Ciências da Saúde, Laboratório de Estudos em Reabilitação Funcional (LAERF), Belém, PA, Brazil
| | - Sandra Souza Lima
- Universidade Federal do Pará, Instituto de Ciências Biológicas, Laboratório de Virologia, Pará, PA, Brazil
| | | | - Ricardo Ishak
- Universidade Federal do Pará, Instituto de Ciências Biológicas, Laboratório de Virologia, Pará, PA, Brazil
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Neurologic, clinical, and immunologic features in a cohort of HTLV-1 carriers with high proviral loads. J Neurovirol 2020; 26:520-529. [PMID: 32385802 PMCID: PMC7438297 DOI: 10.1007/s13365-020-00847-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/23/2020] [Accepted: 04/23/2020] [Indexed: 12/16/2022]
Abstract
A high proviral load (PVL) is recognized as a risk factor for human T cell leukemia virus-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), but there is a lack of prospective studies evaluating whether or not HTLV-1 carriers with high PVL are at risk of developing HAM/TSP or other HTLV-1-related diseases. Here, we compare the incidence of clinical manifestations and the cytokine levels in 30 HTLV-1 carriers with high (> 50,000 copies/106 PBMC) and an equal number of subjects with low proviral load. Participants were followed for 3 to 16 years (median of 11 years). The PVL, IFN-γ, TNF, and IL-10 levels were quantified at entry and at the end of the follow-up. Among the self-reported symptoms in the initial evaluation, only the presence of paresthesia on the hands was more frequent in the group with high PVL (p < 0.04). The production of IFN-γ was higher in the group with high PVL group (median of 1308 versus 686 pg/ml, p < 0.011) when compared with the control group in the first assessment. There was no difference in the occurrence of urinary symptoms or erectile dysfunction, periodontal disease, Sicca syndrome, and neurologic signs between the two groups during the follow-up. The observation that none of the HTLV-1 carriers with high PVL and with exaggerated inflammatory response progressed to HAM/TSP indicates that other factors in addition to the PVL and an exaggerated immune response are involved in the pathogenesis of HAM/TSP.
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9
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Casavilca-Zambrano S, Alarcon JO, Boluda S. Non-neoplastic neurological and ophthalmological disease. Semin Diagn Pathol 2020; 37:110-113. [DOI: 10.1053/j.semdp.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Schierhout G, McGregor S, Gessain A, Einsiedel L, Martinello M, Kaldor J. Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies. THE LANCET. INFECTIOUS DISEASES 2019; 20:133-143. [PMID: 31648940 DOI: 10.1016/s1473-3099(19)30402-5] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus that causes a lifelong infection. Several diseases, including an aggressive form of leukaemia, have been designated as associated with HTLV-1, whereby having HTLV-1 is a necessary condition for diagnosis. Beyond these diseases, there is uncertainty about other health effects of HTLV-1. We aimed to synthesise evidence from epidemiological studies on associations between health outcomes and HTLV-1. METHODS For this systematic review and meta-analysis, we searched Embase, MEDLINE, MEDLINE In-Process, and Global Health for publications from their inception to July, 2018. We included cohort, case-control, and controlled cross-sectional studies that compared mortality or morbidity between people with and without HTLV-1. We excluded studies of psychiatric conditions, of symptoms or clinical findings only, of people who had undergone blood transfusion or organ transplant, and of population groups defined by a behavioural characteristic putting them at increased risk of co-infection with another virus. We extracted the risk estimates (relative risks [RRs] or odds ratios [ORs]) that reflected the greatest degree of control for potential confounders. We did a random-effects meta-analysis for groups of effect estimates where case ascertainment methods, age groups, and confounders were similar, presenting pooled estimates with 95% CIs and prediction intervals. FINDINGS Of the 3318 identified studies, 39 met the inclusion criteria, examining 42 clinical conditions between them. The adjusted risk of death due to any cause was higher in people with HTLV-1 when compared with HTLV-1-negative counterparts (RR 1·57, 95% CI 1·37-1·80). From meta-analysis, HTLV-1 was associated with increased odds of seborrheic dermatitis (OR 3·95, 95% CI 1·99-7·81), Sjogren's syndrome (3·25, 1·85-5·70), and, inversely, with lower relative risk of gastric cancer (RR 0·45, 0·28-0·71). There were a further 14 diseases with significant associations or substantially elevated risk with HTLV-1 from single studies (eczema [children]; bronchiectasis, bronchitis and bronchiolitis [analysed together]; asthma [males]; fibromyalgia; rheumatoid arthritis; arthritis; tuberculosis; kidney and bladder infections; dermatophytosis; community acquired pneumonia; strongyloides hyperinfection syndrome; liver cancer; lymphoma other than adult T-cell leukaemia-lymphoma; and cervical cancer). INTERPRETATION There is a broad range of diseases studied in association with HTLV-1. However, the elevated risk for death among people with HTLV-1 is not explained by available studies of morbidity. Many of the diseases shown to be associated with HTLV-1 are not fatal, and those that are (eg, leukaemia) occur too rarely to account for the observed mortality effect. There are substantial research gaps in relation to HTLV-1 and cardiovascular, cerebrovascular, and metabolic disease. The burden of disease associated with the virus might be broader than generally recognised. FUNDING Commonwealth Department of Health, Australia.
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Affiliation(s)
- Gill Schierhout
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia; The George Institute for Global Health, Faculty of Medicine, University of New South Wales Newtown, NSW, Australia.
| | - Skye McGregor
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Antoine Gessain
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France; CNRS, UMR3569, Paris, France
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute Central Australia, Alice Springs, NT, Australia
| | - Marianne Martinello
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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de Oliveira CJV, Carneiro Neto JA, Andrade RCP, de La Glória Orge M, Liberato de Matos SNF, Rocha PN, Marcelino de Carvalho Filho E. Hormonal and Psychogenic Risk Factors for Erectile Dysfunction in Men with HTLV-1. J Sex Med 2019; 16:1763-1768. [PMID: 31521570 DOI: 10.1016/j.jsxm.2019.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) is associated with neurological damage due to human T-lymphotropic virus 1 (HTLV-1) infection, but hormonal and psychogenic factors also cause ED. AIM To evaluate the association of psychogenic and hormonal factors with ED in men infected with HTLV-1. METHODS In this cross-sectional study, we compared total testosterone, follicle stimulating hormone, luteinizing hormone, prolactin, anxiety symptoms, depressive symptoms, and neurologic manifestations in HTLV-1-infected men with or without ED. The International Index of Erectile Function was used to determine the degree of ED. Participants were grouped according to Osame's Motor Disability Scale and the Expanded Disability Status Scale: HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP), probable HAM/TSP, or HTLV-1 carrier. Chi-square and Fisher's exact tests were used to compare the groups, and regression analyses were used to show predictors of ED. MAIN OUTCOME MEASURE Sexual hormonal levels, psychogenic factors, and neurologic disabilities were found to be associated with ED. RESULTS ED was associated with age older than 60 years (P < .001), degree of neurologic involvement (P < .001), depression (P = .009), and anxiety (P = .008). In the multivariate analyses, only age and degree of neurological injury remained as risk factors for ED. CLINICAL IMPLICATIONS Neurological manifestations are a stronger predictor of ED than hormonal and psychogenic factors in HTLV-1-infected men. STRENGTHS & LIMITATIONS The statistical power of the study was limited due to the low number of participants, but neurologic manifestations were clearly associated with ED. There was no strong association between hormonal and psychogenic factors and ED. CONCLUSION Hormonal and psychogenic factors did not show a strong association with ED in individuals with HTLV-1, but neurological manifestations were strongly associated with ED in these individuals. de Oliveira CJV, Neto, JAC, Andrade RCP, et al. Hormonal and Psychogenic Risk Factors for Erectile Dysfunction in Men with HTLV-1. J Sex Med 2019; 16:1763-1768.
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Affiliation(s)
- Cassius José Vitor de Oliveira
- Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil; Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil
| | - José Abraão Carneiro Neto
- Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil; Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rosana C P Andrade
- Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil; Physical Therapy Department, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria de La Glória Orge
- Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Sheila Nunes F Liberato de Matos
- Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil; Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Paulo Novis Rocha
- Department of Medicine and Diagnostic Support, Medical School of Bahia of the Federal University of Bahia, Salvador, Bahia, Brazil
| | - Edgar Marcelino de Carvalho Filho
- Immunology Service, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil; Department of Medicine and Diagnostic Support, Medical School of Bahia of the Federal University of Bahia, Salvador, Bahia, Brazil; Instituto Gonçalo Moniz-Fiocruz, Salvador, Bahia, Brazil.
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Haziot ME, Gascon MR, Assone T, Fonseca LAM, Luiz ODC, Smid J, Paiva AM, Marcusso RMDN, de Oliveira ACP, Casseb J. Detection of clinical and neurological signs in apparently asymptomatic HTLV-1 infected carriers: Association with high proviral load. PLoS Negl Trop Dis 2019; 13:e0006967. [PMID: 31042700 PMCID: PMC6513103 DOI: 10.1371/journal.pntd.0006967] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/13/2019] [Accepted: 04/08/2019] [Indexed: 01/11/2023] Open
Abstract
Several studies suggest that HTLV-1 infection may be associated with a wider spectrum of neurologic manifestations that do not meet diagnostic criteria for HAM/TSP. These conditions may later progress to HAM/TSP or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. Our aim was to determine the prevalence of HTLV-1-associated disease in subjects without HAM/TSP, and the relationship between these findings with HTLV-1 proviral load (PVL). Methods: 175 HTLV-1-infected subjects were submitted to a careful neurological evaluation, during their regular follow up at the HTLV outpatient clinic of the Institute of Infectious Diseases “Emilio Ribas”, São Paulo city, Brazil. Clinical evaluation and blinded standardized neurological screening were performed for all the subjects by the same neurologist (MH). Results: After the neurological evaluation, 133 patients were classified as asymptomatic and 42 fulfilled the criteria for intermediate syndrome (IS). The mean age of the enrolled subjects was 46.3 years and 130 (74.3%) were females. Clinical classification shows that neurological symptoms (p<0.001), visual disorders (p = 0.001), oral conditions (p = 0.001), skin lesions (p<0.001), bladder disorders (p<0.001), and rheumatological symptoms (p = 0.001), were strongly associated to IS, except for disautonomy (p = 0.21). A multivariate analysis revealed that HTLV-1 proviral load, oral conditions, bladder disorders and rheumatological symptoms were independently associated with the IS. Conclusions: We found some early alterations in 42 patients (24%), particularly the presence of previously not acknowledged clinical and neurological symptoms, among subjects previously classified as "asymptomatic", who we reclassified as having an intermediate syndrome. At least 5–10 million people live with the Human T-Cell Lymphotropic Virus type 1 (HTLV-1) worldwide, and around 0.25–5% of them may develop HTLV-1-associated myelopathy/Tropical spastic paraparesis (HAM/TSP), which is associated with chronic inflammation. In this study, involving 175 HTLV-1-infected subjects originally classified as asymptomatic, we found that 42 of them in reality presented some early clinical conditions, including alterations related not only to the neurological system, but also to the eyes and the skin. We called such conditions intermediate syndrome. Thus, it seems reasonable to suggest that all HTLV-1-infected subjects should be monitored for symptoms that may arise earlier in the course of their infection.
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Affiliation(s)
- Michel E. Haziot
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo, SP, Brazil
| | - M. Rita Gascon
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo, SP, Brazil
| | - Tatiane Assone
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | | | - Olinda do Carmo Luiz
- Department of Preventive Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Jerusa Smid
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo, SP, Brazil
| | - Arthur M. Paiva
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | | | | | - Jorge Casseb
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
- * E-mail:
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Relationship Between Clinical and Urodynamic Findings in HTLV-1-Infected Patients with HAM/TSP. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.90198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Khairallah M, Mahendradas P, Curi A, Khochtali S, Cunningham ET. Emerging Viral Infections Causing Anterior Uveitis. Ocul Immunol Inflamm 2019; 27:219-228. [PMID: 30794475 DOI: 10.1080/09273948.2018.1562080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To review the systemic and ocular manifestations of specific emergent viral infectious diseases relevant to the ophthalmologist with particular emphasis on anterior uveitis Methods: Review of literature. RESULTS Arboviral diseases are among the most important emergent and resurgent human infections, occurring mostly in tropical and subtropical zones, but appearing in virtually all regions of the world as a result of climate change, travel, and globalization. Arboviral infections are transmitted to humans by the bite of hematophagous arthropods, mainly mosquitoes. Systemic disease may range from asymptomatic to life-threatening. A wide variety of ocular manifestations, including uveitis, has been reported in association with these emerging viral diseases. Numerous viruses other than arboviruses also have been recently recognized as a potential cause of uveitis. CONCLUSIONS Proper clinical diagnosis of any emerging infectious disease is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by detection of virus-specific DNA or antivirus antibodies in serum.
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Affiliation(s)
- Moncef Khairallah
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
| | | | - Andre Curi
- c Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases , Oswaldo Cruz Foundation , Rio de Janeiro , Brazil
| | - Sana Khochtali
- a Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine , University of Monastir , Monastir , Tunisia
| | - Emmett T Cunningham
- d Department of Ophthalmology , California Pacific Medical Center , San Francisco , CA , USA.,e Department of Ophthalmology , Stanford University School of Medicine , Stanford , CA , USA.,f UCSF School of Medicine , The Francis I. Proctor Foundation , San Francisco , CA , USA
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Koyama RVL, Yoshikawa GT, Fujihara S, da Silva Dias GA, Virgolino RR, Rodrigues AR, Medeiros R, Simões Quaresma JA, Fuzii HT. Incomplete myelopathy and human T cell lymphotropic virus type-1 (HTLV-1). J Neurovirol 2018; 25:1-8. [PMID: 30291566 DOI: 10.1007/s13365-018-0677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/01/2018] [Accepted: 09/07/2018] [Indexed: 11/28/2022]
Abstract
This was a cross-sectional prospective study. We performed a multivariate statistical analysis of the neurological signs and symptoms of patients infected with human T cell lymphotropic virus type 1 (HTLV-1) in an attempt to separate them into distinct groups and identify clinical-neurological manifestations that could differentiate the various profiles. The study was performed in the city of Belém (state of Pará), located in the Amazon region of Brazil, from 2014 to 2016. We determined muscle strength and tone, reflexes, sensations, sphincter function, gait, and the Expanded Disability Status Scale score among individuals with HTLV-I. We then used exploratory statistical methods in an attempt to find different profiles and establish distinct groups. We analyzed 60 patients with HTLV-1. The filtering of the data, performed with mixed PCA, gave rise to a streamlined database with the most informative data and suggested the formation of three statistically distinct groups: asymptomatic carriers (AC), mono/oligosymptomatic (MOS), and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSPd), AC and MOS (p = 0.002), AC and HAM/TSPd (p < 0.001), and HAM/TSPd and MOS (p = 0.001). The subsequent cluster analysis confirmed the formation of three clusters. The classification and regression tree demonstrated that altered gait was the most important variable for the classification of an individual with HAM/TSPd and that, in the absence of this impairment, hyperreflexia characterized MOS. The present study was able to separate patients infected by HTLV-1 into three clinical groups (AC, HAM/TSPd, and MOS) and identify clinical manifestations that could differentiate the various patient groups.
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Affiliation(s)
- Roberta Vilela Lopes Koyama
- Center of Biological and Health Sciences, Pará State University, Tv Perebebuí, 2623, Marco, Belem, PA, 66095-662, Brazil.
| | - Gilberto Toshimitsu Yoshikawa
- Institute of Health Sciences, Federal University of Pará, Av Generalíssimo, 94, Umarizal, Belem, PA, 66050-160, Brazil
| | - Satomi Fujihara
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | - George Alberto da Silva Dias
- Center of Biological and Health Sciences, Pará State University, Tv Perebebuí, 2623, Marco, Belem, PA, 66095-662, Brazil
| | - Rodrigo Rodrigues Virgolino
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | - Anderson Raiol Rodrigues
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | - Rita Medeiros
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
| | | | - Hellen Thaís Fuzii
- Tropical Medicine Group, Federal University of Pará, Av Generalíssimo, 92, Umarizal, Belem, PA, 66055-240, Brazil
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Echevarria-Lima J, de Abreu Pereira D, de Oliveira TS, de Melo Espíndola O, Lima MA, Celestino Leite AC, Sandim V, Rodrigues Nascimento C, E Kalume D, B Zingali R. Protein Profile of Blood Monocytes is Altered in HTLV-1 Infected Patients: Implications for HAM/TSP Disease. Sci Rep 2018; 8:14354. [PMID: 30254298 PMCID: PMC6156329 DOI: 10.1038/s41598-018-32324-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 08/12/2018] [Indexed: 12/27/2022] Open
Abstract
Human T-cell lymphotropic virus type-1 (HTLV-1) is the etiological agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The endothelial breakdown and migration of leukocytes, including monocytes, to the spinal cord are involved in HAM/TSP development. Monocytes from HTLV-1-infected individuals exhibit important functional differences when compared to cells from uninfected donors. Using proteomic shot gun strategy, performed by nanoACQUITY-UPLC system, we analyzed monocytes isolated from peripheral blood of asymptomatic carriers (AC), HAM/TSP and uninfected individuals. 534 proteins were identified among which 376 were quantified by ExpressionE software. Our study revealed a panel of changes in protein expression linked to HTLV-1 infection. Upregulation of heat shock proteins and downregulation of canonical histone expression were observed in monocytes from HTLV-1-infected patients. Moreover, expression of cytoskeleton proteins was increased in monocytes from HTLV-1-infected patients, mainly in those from HAM/TSP, which was confirmed by flow cytometry and fluorescence microscopy. Importantly, functional assays demonstrated that monocytes from HAM/TSP patients present higher ability for adhesion and transmigration thought endothelium than those from AC and uninfected individuals. The major changes on monocyte protein profile were detected in HAM/TSP patients, suggesting that these alterations exert a relevant role in the establishment of HAM/TSP.
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Affiliation(s)
- Juliana Echevarria-Lima
- Lab. de Imunologia Básica e Aplicada, Depto. of Immunology, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
| | - Denise de Abreu Pereira
- Unidade de Espectrometria de Massas e Proteômica (UEMP), Instituto de Bioquímica Médica Leopoldo de Meis and Instituto Nacional de Biologia Estrutural e Bioimagem (INBEB), UFRJ, Rio de Janeiro, RJ, Brazil
- Programa de Oncobiologia Celular e Molecular, Coordenação Geral de Ensino e Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Thais Silva de Oliveira
- Lab. de Imunologia Básica e Aplicada, Depto. of Immunology, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Otávio de Melo Espíndola
- Lab. de Pesquisa Clínica em Neuroinfecções, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Marco Antonio Lima
- Lab. de Pesquisa Clínica em Neuroinfecções, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ana Cláudia Celestino Leite
- Lab. de Pesquisa Clínica em Neuroinfecções, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Vanessa Sandim
- Unidade de Espectrometria de Massas e Proteômica (UEMP), Instituto de Bioquímica Médica Leopoldo de Meis and Instituto Nacional de Biologia Estrutural e Bioimagem (INBEB), UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Dario E Kalume
- Lab. Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Russolina B Zingali
- Unidade de Espectrometria de Massas e Proteômica (UEMP), Instituto de Bioquímica Médica Leopoldo de Meis and Instituto Nacional de Biologia Estrutural e Bioimagem (INBEB), UFRJ, Rio de Janeiro, RJ, Brazil
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18
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de Oliveira CJV, Neto JAC, Andrade RC, Rocha PN, de Carvalho Filho EM. Risk Factors for Erectile Dysfunction in Men With HTLV-1. J Sex Med 2017; 14:1195-1200. [DOI: 10.1016/j.jsxm.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/10/2017] [Accepted: 08/01/2017] [Indexed: 12/14/2022]
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Acute progressive human T-lymphotropic virus type 1-associated myelopathy with Sjögren's syndrome: Cause or coincidence? J Neurol Sci 2017; 373:33-34. [DOI: 10.1016/j.jns.2016.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/28/2016] [Accepted: 12/13/2016] [Indexed: 11/23/2022]
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Santos DND, Santos KOB, Paixão AB, Andrade RCPD, Costa DT, S-Martin DL, Sá KN, Baptista AF. Factors associated with pain in individuals infected by human T-cell lymphotropic virus type 1 (HTLV-1). Braz J Infect Dis 2016; 21:133-139. [PMID: 28011062 PMCID: PMC9427659 DOI: 10.1016/j.bjid.2016.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction Despite the high prevalence of chronic pain in individuals infected with HTLV-1, predictive and protective factors for its development are still unclear. Objective To identify factors associated with chronic pain in individuals with HTLV-1. Methods This cross-sectional study was conducted in a reference center for treatment of patients infected with HTLV-1 in Salvador, Bahia, Brazil. The study included individuals infected with HTLV-1, over 18 years, and excluded those with difficulty to respond the pain protocol. Data on sociodemographic, health behavior, and clinical characteristics were collected in a standardized way. The prevalence ratio (PR) of pain is described, as well as the factors independently associated with the presence of pain, which were assessed by multiple logistic regression. Results A total of 142 individuals were included in the study, mostly female (62.7%), aged 20–64 years (73.2%), married (61.3%), with less than eight years of education (54.2%), and with a steady income (79.6%). Multivariate analysis showed that being symptomatic for HTLV-1 – sensory manifestations, erectile dysfunction, overactive bladder, and/or HAM/TSP (PR = 1.21, 95% CI: 1.05 to 1.38), self-medication (PR = 1.29, 95% CI: 1.08–1.53), physiotherapy (PR = 1.15, 95% CI: 1.02–1.28), and depression (PR = 1.14, 95% CI: 1.01–1.29) were associated with an increased likelihood of presenting pain. On the other hand, physical activity (PR = 0.79, 95% CI: 0.67–0.93) and religious practice (PR = 0.83, 95% CI: 0.72–0.95) were associated with a decreased likelihood of having pain. Conclusion The use of self-medication, physiotherapy and the presence of depression are independently associated with neurological symptoms in HTLV-1 infected patients. Religious practice and physical activity are both protective for the development of pain.
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Affiliation(s)
- Dislene N Dos Santos
- Universidade Federal da Bahia, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahia, Hospital Professor Edgard Santos, Serviço de Imunologia, Salvador, BA, Brazil
| | - Kionna O B Santos
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil
| | - Alaí B Paixão
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil
| | | | - Davi T Costa
- Universidade Federal da Bahia, Hospital Professor Edgard Santos, Serviço de Imunologia, Salvador, BA, Brazil; Universidade Estadual do Sudoeste da Bahia, Vitoria da Conquista, BA, Brazil
| | - Daniel L S-Martin
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Salvador, BA, Brazil
| | - Katia N Sá
- Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Pós graduação e pesquisa, Salvador, BA, Brazil
| | - Abrahão F Baptista
- Universidade Federal da Bahia, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Pós graduação e pesquisa, Salvador, BA, Brazil.
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San-Martin DL, Santos DND, Baptista AF. Pain prevalence, characteristics and associated factors in human T-cell lymphotropic virus type 1 infected patients: a systematic review of the literature. Braz J Infect Dis 2016; 20:592-598. [PMID: 27768899 PMCID: PMC9427562 DOI: 10.1016/j.bjid.2016.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the pain in patients infected with human T-cell lymphotropic virus type 1, clinically and epidemiologically. Methods This systematic review was based on The PRISMA Statement. Four reviewers searched PUBMED, SciELO, LILACS and BIREME for data from observational studies and clinical trials (n ≥ 30) regarding pain prevalence, characteristics, and associated factors in patients with human T-cell lymphotropic virus type 1. No limits on publication date or language were established. Studies that did not have pain as an outcome measure or not involving human T-cell lymphotropic virus type 1 infected patients were excluded. Results A total of 3013 articles (including duplicates) were found of which seven met the predetermined criteria. The most common pain region was the lower back (53.0%). Non-neuropathic type (ranging from 52.6% to 86.8%) was more frequent in human T-cell lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis participants, and neuropathic pain was more common in human T-cell lymphotropic virus type 1 carriers (53.1%). The pain was mostly reported as moderate or severe. One study showed that chronic pain was negatively associated with quality of life. Discussion Pain is a common complaint in human T-cell lymphotropic virus type 1 infected patients, with lower back pain as the most frequent site. Pain can either be nociceptive, neuropathic, or both, is frequently severe, and negatively affects quality of life. Only studies of two countries were included in this review, limiting the external validity of the conclusions. The heterogeneity of variables prevented us from implementing a meta-analysis. Further research should better characterize the pain and explore its impact on quality of life, especially using longitudinal study design.
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Affiliation(s)
| | - Dislene Nascimento Dos Santos
- Universidade Federal da Bahía, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahía, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA, Brazil
| | - Abrahão Fontes Baptista
- Universidade Federal da Bahía, Laboratório de Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahía, Departamento de Fisioterapia, Salvador, BA, Brazil.
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Andrade RCP, Neto JA, Andrade L, Oliveira TS, Santos DN, Oliveira CJV, Prado MJ, Carvalho EM. Effects of Physiotherapy in the Treatment of Neurogenic Bladder in Patients Infected With Human T-Lymphotropic Virus 1. Urology 2016; 89:33-8. [PMID: 26724409 PMCID: PMC4792685 DOI: 10.1016/j.urology.2015.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/04/2015] [Accepted: 09/17/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy of physiotherapy for urinary manifestations in patients with human T-lymphotropic virus 1-associated lower urinary tract dysfunction. METHODS Open clinical trial was conducted with 21 patients attending the physiotherapy clinic of the Hospital Universitário, Bahia, Brazil. Combinations of behavioral therapy, perineal exercises, and intravaginal or intra-anal electrical stimulation were used. RESULTS The mean age was 54 ± 12 years and 67% were female. After treatment, there was an improvement in symptoms of urinary urgency, frequency, incontinence, nocturia, and in the sensation of incomplete emptying (P < .001). There was also a reduction in the overactive bladder symptom score from 10 ± 4 to 6 ± 3 (P < .001) and an increase in the perineal muscle strength (P <.001). The urodynamic parameters improved, with reduction in the frequency of patients with detrusor hyperactivity from 57.9% to 42.1%, detrusor-sphincter dyssynergia from 31.6% to 5.3%, detrusor hypocontractility from 15.8% to 0%, and detrusor areflexia from 10.5% to 0%, with positive repercussions in the quality of life in all patients. CONCLUSION Physiotherapy was effective in cases of human T-lymphotropic virus 1-associated neurogenic bladder, reducing symptoms, increasing perineal muscle strength, and improving urodynamic parameters and quality of life.
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Affiliation(s)
- Rosana C P Andrade
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - José A Neto
- Immunology Service, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Luciana Andrade
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Tatiane S Oliveira
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Dislene N Santos
- Physiotherapy Department, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Cassius J V Oliveira
- Immunology Service, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Márcio J Prado
- Department of Gynecology, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Edgar M Carvalho
- Immunology Service, Complexo Hospitalar Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Gonçalo Moniz Research Center, Fiocruz, Salvador, Bahia, Brazil; National Institute of Science and Technology in Tropical Diseases (INCT-DT), MCT/CNPq, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, 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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Correlation between clinical symptoms and peripheral immune response in HAM/TSP. Microb Pathog 2015; 92:72-75. [PMID: 26626960 DOI: 10.1016/j.micpath.2015.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 12/14/2022]
Abstract
HTLV-1 infects principally CD4+ T cells that are the main reservoirs of the virus in vivo, which play an important role in the immunological response. Most of the infected patients are asymptomatic. However, 2-3% of patients will develop HAM/TSP or Adult T lymphoma. HAM/TSP is a chronic inflammatory disease of the central nervous system, which is characterized by unremitting myelopathic symptoms. Studies have shown that cytokines levels alterations (IFN-γ and TNF-α) were associated with tissue injury in HAM/TSP. The aims of this study were to compare the gene expression of IFN-γ, IL-4 and IL-10 of asymptomatic and HAM/TSP HTLV-1 infected patients, and to correlate the gene expression with those of clinical symptoms. 28 subjects were included, 20 asymptomatic HTLV-1 and 8 with HAM/TSP. Spasticity was evaluated using the Modified Ashworth Scale and the degree of walking aid was classified on a progressive scale. The relative gene expression of IFN-γ, IL-4, and IL-10 was measured by Real-Time PCR. Results showed high gene expression of IFN-γ for all patients, but it was higher among HAM/TSP. A significant correlation was observed between IFN-γ gene expression and the degree of walking aid, and IFN-γ gene expression was higher among wheelchair users compared to non-wheelchair users. No association was found with IL-4 and IL-10. These findings indicate that HAM/TSP patients express higher amounts of IFN-γ than asymptomatic patients, and more importantly, the expression of this cytokine was strongly correlated with the need of walking aid.
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Neurological manifestations in individuals with HTLV-1-associated myelopathy/tropical spastic paraparesis in the Amazon. Spinal Cord 2015; 54:154-7. [PMID: 26169165 DOI: 10.1038/sc.2015.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/02/2015] [Accepted: 05/28/2015] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN A cross-sectional observational study was conducted. OBJECTIVE The aim was to analyze the clinical-functional profile of patients diagnosed with HTLV-1 (human T-lymphotropic virus type 1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in the Amazon region. SETTING Reference center for HTLV in the city of Belém, state of Pará, Brazil. METHODS Muscle strength, muscle tone, balance and the need for gait assistance among patients with HAM/TSP were evaluated. RESULTS Among the 82 patients infected with HTLV-1, 27 (10 men and 17 women) were diagnosed with HAM/TSP. No statistically significant difference in muscle tone or strength was found between the lower limbs. Muscle weakness and spasticity were predominant in the proximal lower limbs. Patients with HAM/TSP are at a high risk of falls (P=0.03), and predominantly use either a cane or a crutch on one side as a gait-assistance device (P=0.02). CONCLUSION Patients with HAM/TSP exhibit a similar clinical pattern of muscle weakness and spasticity, with a high risk of falls, requiring gait-assistance devices.
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Orge GO, Dellavechia TR, Carneiro-Neto JA, Araújo-de-Freitas L, Daltro CHC, Santos CT, Quarantini LC. Psychiatric Disorders in HTLV-1-Infected Individuals with Bladder Symptoms. PLoS One 2015; 10:e0128103. [PMID: 26018525 PMCID: PMC4446325 DOI: 10.1371/journal.pone.0128103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous studies have reported high rates of depression and anxiety in HTLV-1 infected individuals with the neurological disease and in the asymptomatic phase. No study has investigated the rates in individuals that already show bladder symptoms without severe neurological changes; that is, during the oligosymptomatic phase. The present study investigated patients in this intermediate form on the spectrum of the infection. METHODOLOGY/PRINCIPAL FINDINGS Participants answered a sociodemographic questionnaire, the Mini International Neuropsychiatric Interview Brazilian Version 5.0.0 (MINI PLUS) and the Hospital Anxiety and Depression Scale (HADS). Data analysis was performed in STATA statistical software (version 12.0). Depressive disorder was the most frequent comorbidity. Current depressive disorder was higher in the group of overactive bladder subjects (11.9%), and lifelong depression was more frequent in the HAM/TSP group (35%). The three groups had similar frequencies of anxiety disorders. Increased frequency and severity of anxiety and depression symptoms were observed in the overactive bladder group. CONCLUSION/SIGNIFICANCE The results suggest that individuals with overactive bladders need a more thorough assessment from the mental health perspective. These patients remain an understudied group regarding psychiatric comorbidities.
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Affiliation(s)
- Glória O Orge
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Thais R Dellavechia
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil
| | | | - Lucas Araújo-de-Freitas
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Carla H C Daltro
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil; Escola de Nutrição, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Carlos T Santos
- Departamento de Ciências Exatas, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Lucas C Quarantini
- Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil; Departamento de Neurociências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
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Tanajura D, Castro N, Oliveira P, Neto A, Muniz A, Carvalho NB, Orge G, Santos S, Glesby MJ, Carvalho EM. Neurological Manifestations in Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)-Infected Individuals Without HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis: A Longitudinal Cohort Study. Clin Infect Dis 2015; 61:49-56. [PMID: 25820277 DOI: 10.1093/cid/civ229] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/01/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human T-cell lymphotropic virus type 1 (HTLV-1) is the agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), observed in up to 5% of infected individuals. Despite low prevalence, many HTLV-1-infected patients who do not fulfill criteria for HAM/TSP present with neurological complaints related to sensory, motor, urinary, or autonomic manifestations. The aim of this study was to determine the incidence of neurologic manifestations and risk factors associated with these outcomes. METHODS The incidence of HAM/TSP and new signs and neurologic symptoms were computed in a group of patients enrolled in a cohort study. RESULTS Of 414 subjects, 76 had definite HAM/TSP, 87 had possible or probable HAM/TSP, and 251 subjects had no neurologic manifestation and were selected for analysis. Definite HAM/TSP developed in 5 (1.47%) patients. Follow-up of at least 3 years was achieved in 51% of patients. The incidence rate was computed in 1000 person-years (206 for hand numbness, 187 for feet numbness, 130 for nocturia, and 127 for urgency). Average incidence rate in neurological exam was 76 for leg hyperreflexia, 53 for leg weakness, and 37 for Babinski sign. In the applied Expanded Disability Status Scale, the incidence rate of worsening 1 point was 134 per 1000 person-years. Kaplan-Meier curves stratified by sex and proviral load showed that females and patients with proviral load >50,000 copies/10(6) peripheral blood mononuclear cells had a higher risk of progression. CONCLUSIONS Development of neurological symptoms or signs occurred in up to 30% of asymptomatic subjects during 8 years of follow-up.
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Affiliation(s)
- Davi Tanajura
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador National Institute of Science and Technology of Tropical Diseases, Salvador Department of Natural Sciences, State University of Bahia Southeast, Vitória da Conquista
| | - Néviton Castro
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Paulo Oliveira
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Abraão Neto
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - André Muniz
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Natália B Carvalho
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Glória Orge
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador
| | - Silvane Santos
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador National Institute of Science and Technology of Tropical Diseases, Salvador Department of Biological Sciences, State University of Feira de Santana, Bahia, Brazil
| | - Marshall J Glesby
- Department of Medicine, Weill Cornell Medical College, New York, New York; and
| | - Edgar M Carvalho
- Immunology Service, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador National Institute of Science and Technology of Tropical Diseases, Salvador Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
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[Recurrent facial palsy revealing Human T-lymphotropic virus type 1 (HTLV-1) infection]. Rev Med Interne 2015; 36:701-5. [PMID: 25636977 DOI: 10.1016/j.revmed.2014.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/10/2014] [Accepted: 11/23/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Neurological involvement of Human T-lymphotropic virus type 1 (HTLV-1) mainly results in myelopathy (tropical spastic paraparesis). However, cranial nerve impairment, including facial nerve damage, is rare in patients with HTLV-1 infection. OBSERVATION We report the case of a patient, originally from Caribbean islands, who developed recurrent bilateral facial palsy (six recurrences during the 7-year follow-up). Both blood and cerebrospinal fluid serologies were positive for HTLV-1. The diagnosis of recurring bilateral facial palsy revealing HTLV-1 infection was made. CONCLUSION Our case report underscores that HTLV-1 infection should be considered in patients, coming from endemic areas (Caribbean islands, South America, Japan and Africa), who exhibit recurrent bilateral facial palsy. Our data therefore indicate that HTLV-1 serology should be routinely performed in these patients.
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Kawashiri SY, Nakamura H, Origuchi T, Aoyagi K, Kawakami A. Ultrasonography and magnetic resonance imaging findings of rheumatoid arthritis-like arthritis in a patient with adult T-cell leukemia. Mod Rheumatol 2014; 26:971-975. [PMID: 25119259 DOI: 10.3109/14397595.2014.948529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 43-year-old Japanese woman with adult T-cell leukemia (ATL) developed rheumatoid arthritis-like polyarthritis with dermatitis and skin erosion. Her rheumatoid factor and C-reactive protein results were positive. Musculoskeletal ultrasonography showed intra-articular and peritendinous power Doppler signal-positive synovitis. Plain magnetic resonance imaging showed synovitis of the above lesion and remarkable bone marrow edema/osteitis. She was diagnosed as having ATL-associated arthritis based on the invasion of ATL cells by skin biopsy at the arthritis lesion.
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Affiliation(s)
- Shin-Ya Kawashiri
- a Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,b Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hideki Nakamura
- b Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomoki Origuchi
- c Department of Health Sciences , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kiyoshi Aoyagi
- b Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Atsushi Kawakami
- b Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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Mortazavi H, Baharvand M, Movahhedian A, Mohammadi M, Khodadoustan A. Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Ann Med Health Sci Res 2014; 4:503-10. [PMID: 25221694 PMCID: PMC4160670 DOI: 10.4103/2141-9248.139284] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Xerostomia is a common complaint of nearly half of the elderly population and about one-fifth of younger adults. It causes several signs and symptoms, and compromise oral functions and health-related quality-of-life. Multiple reasons are proposed to describe the etiology of xerostomia such as local factors, psychogenic factors, and systemic diseases. In order to manage xerostomia effectively, identification of the main causality is mandatory. The aim of this review was to present systemic diseases leading to xerostomia with their mechanisms of action. We used various general search engines and specialized databases such as Google, Google Scholar, Yahoo, PubMed, PubMed Central, MedLine Plus, Medknow, EBSCO, ScienceDirect, Scopus, WebMD, EMBASE, and authorized textbooks to find relevant topics by means of Medical Subject Headings keywords such as "xerostomia," "hyposalivations," "mouth dryness," "disease," and "systemic." We appraised 97 English-language articles published over the last 40 years in both medical and dental journals including reviews, meta-analysis, original papers, and case reports. Upon compilation of relevant data, it was concluded that autoimmune diseases most frequently involve salivary glands and cause xerostomia followed by diabetes mellitus, renal failure, and graft-versus-host disease. Moreover, the underlying mechanisms of systemic disease-related xerostomia are: autoimmunity, infiltration of immunocompetent cells, granuloma formation, fibrosis and dehydration, deposition of proteinaceous substances, bacterial infection, and side-effects of medications.
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Affiliation(s)
- H Mortazavi
- Department of Oral and Maxillofacial Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Baharvand
- Department of Oral and Maxillofacial Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Movahhedian
- Dental Student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Mohammadi
- Dental Student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fuzii HT, da Silva Dias GA, de Barros RJS, Falcão LFM, Quaresma JAS. Immunopathogenesis of HTLV-1-assoaciated myelopathy/tropical spastic paraparesis (HAM/TSP). Life Sci 2014; 104:9-14. [DOI: 10.1016/j.lfs.2014.03.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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Hlela C, Bittencourt A. Infective dermatitis associated with HTLV-1 mimics common eczemas in children and may be a prelude to severe systemic diseases. Dermatol Clin 2014; 32:237-48. [PMID: 24680009 DOI: 10.1016/j.det.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Infective dermatitis associated with human T-cell lymphotropic virus type 1 (HTLV-1) (IDH) is a chronic dermatitis that has been observed in a variable proportion of HTLV-1-infected children. IDH may serve as an early clinical marker for HTLV-1 infection and an indicator of increased risk for developing other HTLV-1-associated conditions. Factors that lead only some infected children to develop IDH are poorly understood. The variable clinical presentation of IDH, in particular its chronicity, the morphology and distribution of the lesions, and its clinical resemblance to other cutaneous inflammatory conditions, make it necessary to distinguish it from other common dermatoses.
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Affiliation(s)
- Carol Hlela
- Division of Dermatology, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape 7700, South Africa.
| | - Achiléa Bittencourt
- Laboratory Service, Complexo Hospitalar Universita'rio Prof Edgars Santos, University of Bahia, Rua Augusto Viana, s/n-Canela-40110-160 Salvador, Bahia, Brazil
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Dantas L, Netto E, Glesby MJ, Carvalho EM, Machado P. Dermatological manifestations of individuals infected with human T cell lymphotropic virus type I (HTLV-I). Int J Dermatol 2013; 53:1098-102. [PMID: 24111739 DOI: 10.1111/ijd.12170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human T cell lymphotropic virus type I (HTLV-I) is associated with specific manifestations such as adult T cell lymphoma/leukemia (ATLL), HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), HTLV-I-associated uveitis, and infective dermatitis associated with HTLV-I (IDH). Although ATLL and IDH are considered specific manifestations of HTLV-I infection, several dermatological manifestations have been described in HTLV-I seropositive patients. OBJECTIVES This study was conducted to determine the prevalences of skin lesions in patients infected with HTLV-I in an area of Brazil endemic for HTLV-I infection and to compare these prevalences with those in seronegative individuals in the same region. METHODS A prevalence study was conducted between 2008 and 2010 with two groups of individuals comprising, respectively, 179 HTLV-I seropositive (positive enzyme-linked immunosorbent assay [ELISA] and positive Western blot analysis) and 193 HTLV-I seronegative individuals (ELISA-negative). The subjects were selected on a random basis and evaluated using a questionnaire to obtain epidemiological and clinical data. A physical examination was performed to verify the presence of skin lesions. RESULTS Superficial mycoses were found in 54 (30.2%) seropositive subjects and in 26 (13.5%) of the seronegative group (P < 0.001). Xerosis was found in 39.1% of HTLV-I infected subjects and in 9.3% of seronegative controls (P < 0.001). Ichthyosis was diagnosed in nine (5.0%) HTLV-I seropositive subjects but in none of the control group (P = 0.001). A diagnosis of seborrheic dermatitis was made in 43 (24.0%) HTLV-I infected subjects and in 24 (12.4%) seronegative controls (P = 0.004). Furthermore, dermatological manifestations were more intense in the HTLV-I seropositive group. CONCLUSIONS Several dermatological manifestations are more common and more severe in HTLV-I seropositive subjects. The presence of these manifestations in an area endemic for HTLV-I infection may provide some clues in the investigation of this infection.
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Affiliation(s)
- Lorena Dantas
- Immunology Service, Federal University of Bahia (UFBA), Salvador, BA, Brazil
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Toledo-Cornell C, Santos S, Orge G, Glesby MJ, Carvalho EM. Soluble IL-2 receptor and beta-2 microglobulin as possible serologic markers of neurologic disease in HTLV-1 infection. J Med Virol 2013; 86:315-21. [PMID: 24027213 DOI: 10.1002/jmv.23711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 12/14/2022]
Abstract
The human T-cell leukemia virus (HTLV-1) is the causative agent of a variety of neurologic diseases, including HTLV-1 Associated Myelopathy (HAM/TSP) and overactive bladder. Investigation of immune markers such as soluble interleukin-2 receptor (sIL-2R) and beta-2 microglobulin (B2M) has shown some promising results in distinguishing patients with neurologic disease from those with carrier status. The objective of the present study was to determine if plasma levels of sIL-2R and B2M are markers of neurologic disease in individuals infected with HTLV-1. The present study was divided into two parts. A cross-sectional study and a nested case control study. In the cross-sectional study, HAM/TSP patients had higher plasma levels of B2M and sIL-2R than patients with overactive bladder and HTLV-1 carriers (P < 0.01 for all comparisons). For the nested case control study, the sIL-2 receptor test was able to distinguish patients with HAM/TSP from patients in the combined group of carriers and patients with overactive bladder with a sensitivity of 75.8% and false positive rate of 25.4%. Plasma levels of these markers did not change with the development of HAM/TSP and overactive bladder in HTLV-1 carrier patients. The present study has shown the importance of sIL-2 receptor in helping identifying HAM/TSP. However, the levels of these makers did not change significantly with the development of neurologic disease.
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Affiliation(s)
- Cristina Toledo-Cornell
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York
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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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Abstract
PURPOSE OF REVIEW Human T-cell lymphotropic virus (HTLV) is the first discovered retrovirus causing malignancy in human. HTLV infection affects host's ocular tolerance and causes various diseases in the eye. Here we discuss the manifestations, mechanisms, treatments, and future directions of HTLV-related ocular diseases. RECENT FININGS: Recent serological researches showed that the number of HTLV-1 carriers in metropolitan area was increasing, although seroprevalence of HTLV-1 in general population was decreased after screening serological tests in blood donors started. The most common clinical entity of uveitis was still HTLV-1 uveitis in HTLV-1 highly endemic area, but prevalence of HTLV-1 uveitis varies in different parts of the world. As for treatment of inflammation, tacrolimus and 5-azacytidine were reported to be effective for autoimmune manifestations in HTLV-1-related overlap syndrome (deratomyositis/Sjogren's syndrome) and HTLV-1-related myelodysplastic syndrome. Interleukin-2 receptor targeted therapies improved scleritis in patients with adult T-cell leukemia/lymphoma caused by HTLV-1. Basic researches identified that HTLV-1 tax and HTLV-1 basic leucine zipper factor play critical roles in the HTLV-1-related disease and are now being investigated as targeted therapies. SUMMARY Development of modern molecular biology makes it possible to reveal deep insights of HTLV-1-related ocular diseases. Although effective therapies based on basic researches have been reported, further endeavor is necessary to establish much more specific treatments of the ocular diseases.
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Affiliation(s)
- Koju Kamoi
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
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Human T-lymphotropic Virus Type I (HTLV-I) Proviral Load and Clinical Features in Iranian HAM/TSP Patients: Comparison of HTLV-I Proviral Load in HAM/TSP Patients. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2013; 16:268-72. [PMID: 24470875 PMCID: PMC3881253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 12/20/2012] [Indexed: 12/03/2022]
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Shoeibi A, Etemadi M, Moghaddam Ahmadi A, Amini M, Boostani R. "HTLV-I Infection" Twenty-Year Research in Neurology Department of Mashhad University of Medical Sciences. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2013; 16:202-7. [PMID: 24470862 PMCID: PMC3881242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Abstract
Human T-cell lymphotropic virus (HTLV) types 1 and 2 belong to the Oncorna group of retroviridae, a large family of viruses, grouped initially by pathogenic features, but later revised on the basis of genome structure and nucleotide sequence. HTLV-I was the first discovered human retrovirus to be associated with a malignancy in 1980. The malignancy, first described by Uchiyama and co-workers in southwestern Japan, was named Adult T-cell Leukemia/Lymphoma (ATL) and characterized with cutaneous and respiratory involvement, hepatosplenomegaly, lymphadenopathy and various metabolic abnormalities such as hypercalcemia. The HTLV-I has been known to be endemic to certain parts of Iran like the province of Khorasan in the northeast since 1990, with a 2.3% prevalence rate of infection. The main manifestations of HTLV-I infection are neurologic and hematologic (such as ATL) disorders, but it has also other manifestations such as uveitis, arthritis, dermatitis, vitiligo and lymphocytic alveolitis. Its main neurologic manifestation is a chronic progressive myelopathy that is referred to HTLV-I Associated Myelopathy (HAM) in Japan and Tropical Spastic Paraparesis (TSP) in Caribbean. But other disorders such as peripheral neuropathy, polyradiculoneuropathy, myopathy, peripheral facial paresis, and so on have been reported too. In this review we wish to give some brief information on the different aspects (including epidemiology, pathogenesis and pathology, clinical findings, and treatment) of HTLV-I infection according to our twenty-year researches. The department of neurology of Mashhad University of Medical Sciences has been a pioneer in researches on HTLV-I in the last twenty years.
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Affiliation(s)
- Ali Shoeibi
- Assistant Professor of Neurology, Mashhad University of Medical Sciences
| | | | | | - Mona Amini
- Resident of Neurology, Mashhad University of Medical Sciences
| | - Reza Boostani
- Assistant Professor of Neurology, Mashhad University of Medical Sciences
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Currer R, Van Duyne R, Jaworski E, Guendel I, Sampey G, Das R, Narayanan A, Kashanchi F. HTLV tax: a fascinating multifunctional co-regulator of viral and cellular pathways. Front Microbiol 2012; 3:406. [PMID: 23226145 PMCID: PMC3510432 DOI: 10.3389/fmicb.2012.00406] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 11/12/2012] [Indexed: 12/18/2022] Open
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) has been identified as the causative agent of adult T-cell leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The virus infects between 15 and 20 million people worldwide of which approximately 2-5% develop ATL. The past 35 years of research have yielded significant insight into the pathogenesis of HTLV-1, including the molecular characterization of Tax, the viral transactivator, and oncoprotein. In spite of these efforts, the mechanisms of oncogenesis of this pleiotropic protein remain to be fully elucidated. In this review, we illustrate the multiple oncogenic roles of Tax by summarizing a recent body of literature that refines our understanding of cellular transformation. A focused range of topics are discussed in this review including Tax-mediated regulation of the viral promoter and other cellular pathways, particularly the connection of the NF-κB pathway to both post-translational modifications (PTMs) of Tax and subcellular localization. Specifically, recent research on polyubiquitination of Tax as it relates to the activation of the IkappaB kinase (IKK) complex is highlighted. Regulation of the cell cycle and DNA damage responses due to Tax are also discussed, including Tax interaction with minichromosome maintenance proteins and the role of Tax in chromatin remodeling. The recent identification of HTLV-3 has amplified the importance of the characterization of emerging viral pathogens. The challenge of the molecular determination of pathogenicity and malignant disease of this virus lies in the comparison of the viral transactivators of HTLV-1, -2, and -3 in terms of transformation and immortalization. Consequently, differences between the three proteins are currently being studied to determine what factors are required for the differences in tumorogenesis.
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Affiliation(s)
- Robert Currer
- National Center for Biodefense and Infectious Diseases, George Mason University Manassas, VA, USA
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Abstract
Human T cell lymphotropic virus type 1 (HTLV-1) is the first retrovirus described as a causative agent of human disease. Following adult T cell leukemia/lymphoma and HLTV-1-associated myelopathy/tropical spastic paraparesis, HTLV-1 uveitis (HU) has been established as a distinct clinical entity caused by HTLV-1 based on seroepidemiological, clinical, and virological studies. HU is one of the most common causes of uveitis in endemic areas of Japan and can be a problematic clinical entity all over the world. HU occurs with a sudden onset of floaters and foggy vision, and is classified as an intermediate uveitis. Analysis of infiltrating cells in eyes with HU revealed that the majority of infiltrating cells were CD3(+) T cells, but not malignant cells or leukemic cells based on their T cell receptor usage. HTLV-1 proviral DNA, HTLV-1 protein, and viral particles were detected from infiltrating cells in eyes with HU. HTLV-1-infected CD4(+) T cell clones established from infiltrating cells in eyes with HU produced large amounts of various inflammatory cytokines, such as IL-1, IL-6, IL-8, TNF-α, and interferon-γ. Taken together, HU is considered to be caused by inflammatory cytokines produced by HTLV-1-infected CD4(+) T cells that significantly accumulate in eyes; therefore, topical and/or oral corticosteroid treatment is effective to treat intraocular inflammation in patients with HU. Further investigation is needed to establish a specific treatment for HU.
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Affiliation(s)
- Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo, Japan
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