Clinical profile of human T-lymphotropic virus type I: a forgotten infection in pediatrics

Abstract

The Human T-lymphotropic virus type 1 (HTLV-1), a retrovirus with oncogenic properties, affects around ten to twenty million people worldwide. The most common disorders associated with HTLV-1 infection are T-cell leukemia/lymphoma (ALT) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Studies have reported other clinical manifestations in HTLV-1 seropositive patients, including inflammatory disorders, co-infections with opportunistic agents, and pulmonary diseases. Objective: Here, we aim to describe a cohort of juvenile patients with confirmed HTLV-1 infection that showed clinical manifestations other than neurological symptoms. Methodology and patients: Retrospective analysis of clinical data describing background and clinical findings of 12 juvenile patients with confirmed HTLV-1 infection, attended during January 2018 to February 2020 in a pediatric referral hospital in Cali, Colombia. Results: 11 out 12 patients were from Colombia´s Pacific coast, 10 suffered from significant nutritional deficiencies. Six exhibited dermatological findings, 3 compatible with infective dermatitis. None of the cases exhibited clinical or laboratory findings suggesting ALT or HAM/TPS. Eight patients had structural lung disease assessed by chest Computed Tomography (CT) scans; 4 of them tested positive for galactomannan antigen in bronchoalveolar fluid suggesting pulmonary aspergillosis, and 2 others exhibited a positive PCR testing for tuberculosis. Three patients were diagnosed with autoimmune disorders; 1 patient with Crohn´s Diseases, 1 case of autoimmune thrombocytopenic purpura, and a patient with Vogt-Koyanagi-Harada syndrome (non-granulomatous uveitis). Conclusions: There is a broad range of clinical manifestations in pediatric HTLV-1 patients, and the clinician should consider structural pulmonary disease, opportunistic co-infections and autoimmune disorders in the diagnostic algorithm.

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

“…In case series in the adult population of Australian aborigines and in Japanese series, the radiological images found were centrilobular nodules, ground glass opacities and bronchovascular thickening (bronchiectasis); compatible with what is found in this series (40). In addition to the damage to the lung structure, there is an overlapping infection by M. tuberculosis that has also been described in the literature, observed in two of the sixteen patients described (9,23,35). In a study carried out in Brazil, they attributed a three times greater risk of acquiring pulmonary tuberculosis when there was a HTLV-1 infection, both reflecting conditions of vulnerability and poverty in this group of patients (9).…”

“…One of the cases described in the last cohort is a patient with progressive loss of gait and progressive muscle compromise with signs of active inflammation and sequelae that are not compatible with HAM, since he doesn't present paresis. However, the described characteristics could correspond to polymyositis, which has been described previously in the literature as one of the expressions of autoimmunity present in patients with HTLV-1 (35,37,38). The most frequent expressions in this group of patients were respiratory manifestations with secondary pulmonary involvement.…”

“…The proviral load was not available for the patients evaluated. Twelve patients were reported in the initial series, with an additional of four patients recruited for this work (35). Of a total of sixteen patients, thirteen patients came from the Colombian Pacific coast, namely, the states of Valle del Cauca, Choco, Cauca and Nariño.…”

Human T-lymphotropic virus type 1 and aspergillosis: an invisible co-infection

“…DID diagnosis. In summary, pulmonary aspergillosis has been described as an opportunistic infection in patients with ATL and HAM 3 , 4 , and in HTLV-1-infected pediatric/juvenile patients with bronchiectasis and subpleural bullae 5 , and, as shown herein, in a patient with recurrent TB. Recently, a retrospective study on the medical records of 91 patients diagnosed with chronic pulmonary aspergillosis in Sao Paulo State, Brazil, disclosed having pulmonary tuberculosis as the most common underlying factor in such patients, followed by smoking 6 .…”

Neumonía por coinfección de Aspergillus fumigatus de Pneumocystis jirovecii en un paciente no VIH: Reporte de caso

“…", por bacterias como TBC, por virus como HPV y por hongos Aspergillosis y paracoccidioidomicosis, como ha sido reconocido entre varios investigadores de América Latina y habitualmente desarrollan cursos clínicos, agresivos y rápidos, incluso, en presencia de estadios pre leucémicos, las infecciones respiratorias son severas e incluyen Pneumocystis jirovecii. [2] Nosotros, en reciente publicación, describimos Aspergillosis severa en niños de Colombia, cuyo criterio de inmunodeficiencia, fue tener HTLV [3] . Asimismo, se han reconocido los daños pulmonares que ocurren en pacientes con HTLV que los llevan a infecciones frecuentes por TBC, por neumonía o por micosis pulmonar como en este caso.…”