Prevalence of human T-cell lymphotropic virus I and II in Colombian blood donors, 2001-2014: Implications for transfusion safety

Case Series: Pediatric Human T-Lymphotropic Virus Type 1 and Its Clinical Expression

Purpose

Human T-lymphotropic Virus type 1 (HTLV-1) was the first retrovirus to be identified and associated with oncogenic activity. It is estimated that approximately 10–20 million people in the world are infected with it. The clinical manifestations most commonly associated with HTLV-1 infection include T-cell leukemia/lymphoma and myelopathy associated to HTLV-1 infection. The purpose of this study is to describe clinical and demographic characteristics in pediatric patients with HTLV-1 infection.

Methodology and Patients

Ambispective case series analysis, with collection of medical records and subsequent description of demographic data (sex, origin, age) and clinical characteristics in 16 patients with HTLV-1 infection were collected. Twelve of these patients were part of an initially reported cohort and four were recruited later in the study. The patients were collected between January 2017 and July 2021 in a pediatric institution in Cali, in a reference hospital in the southwest region of Colombia.

Results

Thirteen of a total of sixteen patients came from the Colombian Pacific coast, where nine were with significant nutritional deficiencies. Seven showed dermatological compromise. Eight patients presented images compatible with inflammation and chronic lung injury, and six of the eight patients were with opportunistic infections. Coinfection with other microorganisms was also observed where one case presented with meningeal tuberculosis, another patient presented with simultaneous infections, namely, malaria, leptospirosis and toxoplasmosis, and a third patient presented intestinal parasitosis and soft tissue infection by Streptococcus pyogenes. Three patients had concomitant autoimmune diseases and a fourth patient was highly suspicious of having polymyositis.

Conclusions

The different clinical findings with simultaneous HTLV-1 infection broaden the panorama to suspect infection by this virus. More studies are required to achieve a direct association between structural lung disease, autoimmune diseases, immunodeficiency and HTLV-1 infection. This study aims to raise interest and awareness of an ancient but neglected disease.

Palmo-plantar hyperkeratosis associated with HTLV-1 infection: a case report

Background

Palmoplantar hyperkeratosis is a cutaneous manifestation that had not been clearly associated with infection by the human T-cell lymphotropic virus, which is a retrovirus that in most cases does not develop clinical pathologies and its symptoms may be undetected. The skin is one of the most affected organs, however until now only seborrheic dermatitis, xerosis/ichthyosis and infective dermatitis associated with HTLV-1 have been described as cutaneous clinical manifestations of this disease.

Case presentation

We present the case of a 36-year-old male patient with serologically documented HTLV-1 infection, who presented symptoms of diarrhea, malabsorption due to Strongyloides stercoralis, and in whom a physical examination revealed an association with generalized xerosis and palmoplantar keratoderma confirmed by skin biopsy. Other infectious etiologies and malignancy were ruled out. This clinical manifestation was managed with dermal hydration, and skin care which improved the thickened skin and make it less noticeable.

Conclusions

According to our experience, this is the first reported case of palmoplantar keratoderma associated with a human lymphotropic virus infection. This is a skin manifestation that has not been confirmed in conjunction with HTLV-I before. This implies that palmoplantar keratoderma is a new clinical manifestation of this infection, that should be considered in the initial approach of patients in endemic areas with these dermatological characteristics.

Seroprevalence and Trends of HTLV-1/2 among Blood Donors of Santo Domingo, Dominican Republic, 2012-2017

OBJECTIVE

Being a Caribbean country, the Dominican Republic is considered endemic for HTLV-1. Viral screening in blood banks is recommended for this blood borne infection. The purpose of this work is to analyze the seroprevalence and trends of HTLV-1/2 in the Dominican Republic blood donors; it is focused on Santo Domingo, the capital of the country, which has the largest blood donation activity. We also aim at comparing our findings with published data from neighboring countries.

METHODS

We performed a retrospective cross-sectional study of 10 blood centers of Santo Domingo, which reported HTLV and the other blood-transmitted infections in full. They represent more than 40% of the province's blood donations. Annual seroprevalence of HTLV-1/2, period prevalence (2012-2017), and time trend were determined.

RESULTS

A total of 352,960 blood donations were evaluated. The HTLV-1/2 period prevalence was 0.26% (929/352,960)(95% CI: 0.24-0.28%). We also found a marked predominance of replacement donation (90.4%) in comparison to voluntary contributions (9.6%). Therefore, this blood donor study may provide clues on the general prevalence of the infection.

CONCLUSIONS

Seroprevalence of HTLV-1/2 in blood donors of Santo Domingo, Dominican Republic, showed a relatively low and steady trend in the studied period.

Infección por virus HTLV-1/2 confirmada por serología y detección de provirus en pacientes ecuatorianos de paraparesis espástica tropical

Introduccion: La infección con el virus linfotrópico de células T humano (HTLV) de tipo 1 y 2 es endémica en América del Sur. Existen muy pocos reportes clínicos de este retrovirus en pacientes de Ecuador y nunca confirmaron la presencia del virus con el aislamiento o la detección de su ADN. Esta infección se encuentra desatendida por las autoridades de salud pública, sin que existan estudios epidemiológicos de prevalencia a nivel del país. Objetivos: Este estudio tiene como objetivo la detección de infección por HTLV -1/2 en individuos sintomáticos de paraparesis espástica tropical (TSP) utilizando por primera vez en Ecuador diagnóstico serológico y la detección del provirus por biología molecular.Diseño del estudio. Se tomaron muestras de nueve pacientes con un diagnóstico de mielopatía y sospechoso de TSP, que fueron analizadas para la detección del virus HTLV-1/2 usando tres metodologías: ELISA comercial, ensayo de inmunofluorescencia indirecta (IF) y PCR anidada. Resultados: Cinco de los 9 (55.5%) pacientes fueron positivos tanto para la prueba de ELISA como para IF y PCR anidada. Conclusión: La alta prevalencia de infección por HTLV-1/2 entre individuos sintomáticos de mielopatía muestra la endemicidad de este retrovirus en Ecuador, la asociación de HTLV-1/2 con TSP y la necesidad de implementar estrategias de control y prevención para evitar la diseminación de esta enfermedad infecciosa desatendida.

Myelopathy secondary to human T-lymphotropic virus and Treponema pallidum infection: case report

Introduction

The human T-lymphotropic virus has been associated with human disease, affecting CD4+ T, CD8+ T, and B lymphocytes. It can cause T-cell leukemia/lymphoma and HTLV-associated myelopathy.

Case presentation

A 31-year-old woman was admitted after 2 months of cramps, paraparesis, and fecal/urinary incontinence. She was diagnosed with neurosyphilis according to the cerebrospinal fluid analysis. Despite treatment with crystalline penicillin there was no recovery, and anti-HTLV-1/2 tests were positive; therefore, the diagnosis of HTLV-associated myelopathy was made. The patient rejected glucocorticoid treatment; baclofen and carbamazepine were used to treat spasticity and cramps, respectively. The patient has not had progression.

Discussion

HTLV-associated myelopathy is generated by an exaggerated inflammatory response in the central nervous system with clonal expansion of CD4+ T and CD8+ T lymphocytes. There is not a specific and useful treatment; glucocorticoids can reduce inflammation, but do not improve clinical functional outcomes. There is a high prevalence of syphilis and human T-lymphotropic virus co-infection in tropical countries; however, myelopathy as the first clinical manifestation is unusual. The treatment of neurosyphilis could reduce the inflammation into the central nervous system and could decrease the progression of sequelae. This is the first case of myelopathy secondary to viral and treponemal co-infection confirmed in Colombia.

Seroprevalence of human T-lymphotropic virus HTLV and its associated factors in donors of a blood bank of Medellín-Colombia, 2014-2018

BACKGROUND

Research on HTLV in Colombia is limited; despite being an endemic country there are few studies on the magnitude of this infection. The aim of this study was to determine the seroprevalence of HTLV I/II and its associated factors in donors to a blood bank of Medellín Colombia, 2014-2018.

METHODS

This is a cross-sectional study of 52,159 donors with a secondary information source. Seroprevalence of HTLV I/II was determined with its confidence interval and the population characteristics were described by frequency and summary measures. To explore the associated factors, Pearson's Chi square test, Mann-Whitney U test, crude odds ratios were used and they were adjusted by logistic regression in SPSS 25.0.

RESULTS

88% of the population lived in the metropolitan area, 68.5% belonged to the University. 76.2% were altruistic donors (unpaid donors who did not donate to a specific patient). 24.5% were repetitive (paid) donors. 75% of the donors were under 41 years old. The seroprevalence of HTLV I/II was 0.176% (95% CI = 0.139% -0.213%), being statistically lower in repetitive donors and men.

CONCLUSION

The seroprevalence of HTLV I/II infection in the studied blood bank is lower than that reported in other blood banks at the departmental and national levels. In Medellín, it was associated with the frequency of donation and gender, which is useful information for the hemovigilance programs of the city.

A high prevalence of human T-lymphotropic virus (HTLV 1/2) infection among Afro-descendants, Esmeraldas province, Ecuador - need for the implementation of surveys and control programs

Background: Infection with the Human T-cell lymphotropic virus (HTLV) type 1 and 2 is endemic in South America. Although there are reports of the presence of these retroviruses in Ecuador, the infection is usually neglected in healthcare settings and by public health authorities, and no actualized prevalence data are available.

Objectives: This cross-sectional study aimed to estimate, using for the first time to our knowledge in Ecuador immunological and molecular biology methodologies, the prevalence of HTLV-1/2 infection in asymptomatic individuals from a potentially high-risk population of Afro-Ecuadorians in the Province of Esmeraldas.

Study design: Two hundred and twenty-seven plasma samples from asymptomatic individuals were analyzed for the detection of the HTLV-1/2 virus with three methods: a commercial ELISA, an indirect immunofluorescence (IF) assay, and a nested-PCR.

Results: The overall prevalence of HTLV-1/2 antibodies in this population, as determined with an ELISA, was 11.0%. Both the IF assay and the nested-PCR confirmed a prevalence of 3.5%.

Conclusion: The high prevalence of HTLV-1/2 infection among the Afro-Ecuadorian population of Esmeraldas Province shows the need of the implementation of control and prevention interventions to overcome the further dissemination of the infection. To define the real problem of HTLV-1/2 infection in Ecuador, more prevalence studies have to be undertaken in other Afro-Ecuadorian populations and high-risk populations like the indigenous population of the Andes Mountains and the tropical Amazon region.