Manifestações oculares observadas em indivíduos infectados por HTLV-I no Rio de Janeiro

Abstract

Purpose: To evaluate the frequency of ocular manifestations observed in HTLV-I seropositive patients in Rio de Janeiro.Methods: The study included 17 patients with TSP/HAM (tropical spastic paraparesis/HTLV-I associated myelopathy) and 55 HTLV-I seropositive patients without TSP/HAM or ATLL (adult T-cell leukemia/lymphoma).Results: Regarding the TSP/HAM patient samples, we observed a frequency of 11.8% anterior uveitis, 11.8% retinal vasculitis and 5.9% vitreous opacity. In HTLV-I seropositive patients without TSP/ HAM or ATLL, the frequencies of 1.8% retinal vasculitis and 1.8% cotton-wool spot were observed.Conclusion: HTLV-I must be considered as one of the etiological agents to be thought of in those ocular manifestations in endemic areas such as Rio de Janeiro. Manifestações oculares observadas em indivíduos infectados por HTLV-I no Rio de JaneiroFrom the Master of Medicine thesis, elaborated at the Uveitis/AIDS.

Prevalence and characteristics of HTLV-associated uveitis in patients from Bahia, an endemic area for HTLV -1 in Brazil

“…Similar to other reports, the presentation of HAU was mostly bilateral in our patients 18 and localized in the intermediate chamber 18,19 , with asymptomatic or oligosymptomatic presentations consisting of visual disturbances and oaters [18][19][20][21][22] . Changes in the anterior segment of the eye, vitreous cells, macular edema, epiretinal membranes, and abnormalities in retinal pigment distribution were also noted, in consonance with other reports in the literature [18][19][20][21][22] . However, in contrast, no retinal vasculitis was identi ed in the presently studied patients 19,21,22 .…”

“…In the HTLV-1-uninfected control group, herpes simplex and tuberculosis were found to be associated with uveitis (Table 3). Other Brazilian studies investigating ophthalmologic changes in HTLV-1 reported a lower prevalence of HAU (from 1.9-2.85%) than that found herein (7.14%) [19][20][21][22] . However, unlike other reports 18, [20][21][22] , the present study was speci cally designed to determine the prevalence of HAU, and a comprehensive examination procedure was performed in all patients by a single investigator trained in the diagnosis of uveitis.…”

“…However, few studies have attempted to determine the prevalence of HAU worldwide, with reported rates ranging from 1.6% in Argentina to 14.5% in Martinique 17,18 . In Brazil, four studies have described HAU in 1.9-2.85% of patients [19][20][21][22] . However, studies on HAU prevalence only partially consider relevant ophthalmologic ndings and do not perform differential diagnosis of uveitis; moreover, few studies included a control group not infected with HTLV-1 18,19,22 .…”

Ocular lesions in HTLV-1 infected patients from Salvador, State of Bahia: the city with the highest prevalence of this infection in Brazil

“…Indeed, prevalences of 1.93% and 1.82% in asymptomatic and HAM/TSP individuals, respectively, were observed in the City of Belo Horizonte, State of Minas Gerais, in the Southeast region of the country 30 . Only one study reported a prevalence of 11.8% of uveitis in TSP/HAM patients from Rio de Janeiro, also located in the same geographic region 34 . However, in this article, only the anterior uveitis was reported, in disagreement with most studies in Brazil and other countries where intermediate uveitis predominates 20 30 35 .…”

Case report of adult T-cell lymphoma/leukemia

“…Despite the fact that HTLV-1 infections are regarded as endemic in Brazil and highly prevalent in Bahia, Pernambuco and Pará, HTVL-1 and HTVL-2 infections are present in all regions, though with low prevalence among the general population (3,9) . ATLL pathogenesis, though not totally elucidated in humans, is linked with CD4T cell and HTLV-1 infections (17) and some risk factors such as the following : (1) gender, with higher prevalence among women due to their higher vulnerability to sexual transmission (4) ; (2) heredity, linked with higher genetic predisposition to the development of this type of leukemia (18) ; (3) direct correlation between the increase in atypical lymphocytes, proviral load and the aggravation of clinical symptoms (6,11,13) ; (4) low levels of serum HTLV-1 TAX antibody (escape mechanism of infected cells), inasmuch as in normal conditions TAX is able to cause intracellular changes in CD4+ lymphocytes and induce immunological response (5,10,16) ; (5) HTVL-1 vertical transmission via breast-feeding (1,2,18) .…”