Sonia Regina A. A Pinheiro

Epidemiology, Treatment, and Prevention of Human T-Cell Leukemia Virus Type 1-Associated Diseases

SUMMARY Human T-cell leukemia virus type 1 (HTLV-1), the first human retrovirus to be discovered, is present in diverse regions of the world, where its infection is usually neglected in health care settings and by public health authorities. Since it is usually asymptomatic in the beginning of the infection and disease typically manifests later in life, silent transmission occurs, which is associated with sexual relations, breastfeeding, and blood transfusions. There are no prospects of vaccines, and screening of blood banks and in prenatal care settings is not universal. Therefore, its transmission is active in many areas such as parts of Africa, South and Central America, the Caribbean region, Asia, and Melanesia. It causes serious diseases in humans, including adult T-cell leukemia/lymphoma (ATL) and an incapacitating neurological disease (HTLV-associated myelopathy/tropical spastic paraparesis [HAM/TSP]) besides other afflictions such as uveitis, rheumatic syndromes, and predisposition to helminthic and bacterial infections, among others. These diseases are not curable as yet, and current treatments as well as new perspectives are discussed in the present review.

Infecção e doença pelos vírus linfotrópicos humanos de células T (HTLV-I/II) no Brasil

HTLV-I/II infection is present in all regions of Brazil, but its prevalence varies according to the geographical area, being higher in Bahia, Pernambuco and Pará. It has been estimated that Brazil has the highest absolute number of infected individuals in the world. Blood donors screening and research conducted with special groups (indigenous population of Brazil, IV drug users and pregnant women) are the major sources of information about these viruses in our Country. HTLV-I causes adult T cell leukemia/lymphoma (ATLL), HTLV associated myelopathy/tropical spastic paraparesis (HAM/TSP), HTLV associated uveitis (HAU), dermatological and immunological abnormalities. HTLV-II is not consistently associated with any disease. Diagnosis is established using screening (enzymatic assays, agglutination) and confirmatory (Western blot, PCR) tests. The viruses are transmitted by blood and contaminated needles, by sexual relations and from mother to child, especially by breast feeding. Prevention efforts should focus on education of positive blood donors, infected mothers and IV drug users.

Survey for Tick-Borne Zoonoses in the State of Espirito Santo, Southeastern Brazil

Blood samples collected from 201 humans, 92 dogs, and 27 horses in the state of Espirito Santo, Brazil, were tested by polymerase chain reaction, indirect immunofluorescence assays, and indirect enzyme-linked immunosorbent assay for tick-borne diseases (rickettsiosis, ehrlichiosis, anaplasmosis, borreliosis, babesiosis). Our results indicated that the surveyed counties are endemic for spotted fever group rickettsiosis because sera from 70 (34.8%) humans, 7 (7.6%) dogs, and 7 (25.9%) horses were reactive to at least one of the six Rickettsia species tested. Although there was evidence of ehrlichiosis (Ehrlichia canis) and babesiosis (Babesia canis vogeli, Theileria equi) in domestic animals, no human was positive for babesiosis and only four individuals were serologically positive for E. canis. Borrelia burgdorferi-serologic reactive sera were rare among humans and horses, but encompassed 51% of the canine samples, suggesting that dogs and their ticks can be part of the epidemiological cycle of the causative agent of the Brazilian zoonosis, named Baggio-Yoshinari Syndrome.

HTLV-I Associated uveitis, myelopathy, rheumatoid arthritis and Sjögren's syndrome

A 62 year-old white female presented with a 10-year-history of slowly progressive spastic paraparesis, pain and dysesthesia in the lower limbs and sphincter disturbance. A few years after the onset of the neurologic symptoms she developped migratory arthritis with swelling of the knees and pain on palpation of knees and fingers, dry eyes, mouth and skin. Two months before admission she presented bilateral nongranulomatous anterior uveitis. Examination revealed spastic paraparesis with bilateral Babinski sign, a decreased sensation level below L3, decreased vibration sense in the lower extremities, and a postural tremor of the upper limbs. Laboratory work-up disclosed HTLV-I positive tests in the blood and cerebrospinal fluid (CSF), and a mild pleocytosis in the CSF with a normal protein content. Nerve conduction velocity studies were normal. The present case shows the association of uveitis, arthritis and Sjögrens syndrome in a patient with tropical spastic paraparesis/human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy (TSP/HAM), and illustrates the wide spectrum of clinical manifestations which may accompany this infection with this virus.

Isolation of Leishmania sp. from aqueous humor of a patient with cutaneous disseminated leishmaniasis and bilateral iridocyclitis (preliminary report)

The authors report an uncommon case of leishmaniasis with disseminated cutaneous lesions, systemic manifestations and ocular involvement, the latter being characterized by bilateral nongranulomatous iridocyclitis. The severity of the ophthalmologic lesions and its unresponsiveness to therapy (in spite of satisfactory regression of both systemic and cutaneous manifestations) lead to a needle aspiration of the anterior eye chamber content. From this material Leishmania sp was isolated. To our knowledge this is the first time that Leishmania has been shown into the ocular globe.

HTLV-I/II seroprevalence in 55 Brazilian patients with idiopathic uveitis

Human T-cell lymphotropic virus type I has been associated with adult T-cell leukemia and lymphoma, neurological disease (tropical spastic paraparesis or HTLV-I associated myelopathy) and, more recently, uveitis. This virus is highly endemic in some regions of the world, especially in southwest Japan, Caribbean islands, South A m erica and parts o f Central A frica1. The presence of HTLV-I/II in Brazil varies according to the geographical area, with seroprevalence in healthy blood donors ranging from 0.08 to 1.35% in studies conducted by the Ministry of Health5. In Belo Horizonte, the capital of Minas Gerais State, a seroprevalence of 0.32%4 has been observed in eligible blood donors. In Ja p a n , sero p rev alen ce for HTLV-I antibodies among patients with idiopathic uveitis ranges from 35.4 to 44.8%2. In Brazil, to our knowledge, there is no data on HTLV-I seroprevalence among individuals with this diagnosis. From March to September of 1994, we tested 55 patients with idiopathic uveitis for the presence of antibodies to HTLV-I/II by using an ELISA (Ortho Diagnostic Systems, N ew J e r s e y , U SA ). P o s itiv e te s ts w e re confirmed by Western blot (Cambridge Biotech, Maryland, USA). None of the patients presented clinical or laboratorial evidence of systemic disease related to other uveitis types such as toxoplasmosis, syphilis, tuberculosis, ankylosing spondylitis, sarcoidosis, Behcet’s disease or Vogt-Koyanagi-Harada’s disease. The patients’age ranged from 9 to 78 years (mean, 36.2, SD, 17.52). Thirty-six (65.4%) were females and 19 (34.6%) were males. The distribution of the anatomical types of uveitis