Human T-lymphotropic virus - Revision history

Aidan: /* HTLV-1 */

2020-08-24T15:49:35Z

HTLV-1

← Older revision		Revision as of 15:49, 24 August 2020
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	== Background ==		==Background==

	=== Microbiology ===		===Microbiology===

	* Single-stranded negative-sense RNA virus in the [[Retroviridae]] family, genus ''Deltaretrovirus''		*Single-stranded negative-sense RNA virus in the [[Retroviridae]] family, genus ''Deltaretrovirus''
	* Four types:		*Four types:
	** HTLV-1, cause of adult T-cell leukemia-lymphoma and HTLV-associated myelopathy		**HTLV-1, cause of adult T-cell leukemia-lymphoma and HTLV-associated myelopathy
	** HTLV-2, cause of HTLV-associated myelopathy		**HTLV-2, cause of HTLV-associated myelopathy
	** HTLV-3 and HTLV-4 are rare		**HTLV-3 and HTLV-4 are rare

	=== Epidemiology ===		===Epidemiology===

	* HTLV-1 endemic to central Africa, the Caribbean basin, parts of South America, and southwestern Japan		*HTLV-1 endemic to central Africa, the Caribbean basin, parts of South America, and southwestern Japan
	* HTLV-2 endemic to indigenous people in the Americas, and Central African pygmies, as well as injection drug users in North America and Europe		*HTLV-2 endemic to indigenous people in the Americas, and Central African pygmies, as well as injection drug users in North America and Europe
	* Transmitted sexually, parenterally (blood-borne), and vertically (mother-to-child, primarily through breastfeeding)		*Transmitted sexually, parenterally (blood-borne), and vertically (mother-to-child, primarily through breastfeeding)
	* Seroprevalence increases with age and is higher in women than men		*Seroprevalence increases with age and is higher in women than men

	== Clinical Manifestations ==		==Clinical Manifestations==
	{\| class="wikitable"		{\| class="wikitable"
	!Syndrome		!Syndrome
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	\|}		\|}

	=== Adult T-cell Leukemia-Lymphoma (ATL) ===		===Adult T-cell Leukemia-Lymphoma (ATL)===

	* Associated with HTLV-1, with a lifetime risk of 2 to 4% and latent period to 30 to 50 years		*Associated with HTLV-1, with a lifetime risk of 2 to 4% and latent period to 30 to 50 years
	* Aggressive T-cell [[leukemia]] or [[lymphoma]] with four subtypes		*Aggressive T-cell [[leukemia]] or [[lymphoma]] with four subtypes
	** Smoldering (5%), with ≥5% abnormal T-cells but otherwise normal differential, ± skin lesions ± pulmonary involvement		**Smoldering (5%), with ≥5% abnormal T-cells but otherwise normal differential, ± skin lesions ± pulmonary involvement
	** Chronic (19%), with lymphocytosis ≥4 and T-cells >3.5, ± lymphadenopathy/organomegaly/skin lesions/pulmonary involvement		**Chronic (19%), with lymphocytosis ≥4 and T-cells >3.5, ± lymphadenopathy/organomegaly/skin lesions/pulmonary involvement
	** Lymphoma/leukemia (19%), with lymphadenopathy without lymphocytosis; poor prognosis (median 10 months)		**Lymphoma/leukemia (19%), with lymphadenopathy without lymphocytosis; poor prognosis (median 10 months)
	** Acute (57%), with increased leukemic T cells and worsening clinical picture including hypercalcemia; poor prognosis (median 6 months)		**Acute (57%), with increased leukemic T cells and worsening clinical picture including hypercalcemia; poor prognosis (median 6 months)
	* Presents with lymphadenopathy, hepatosplenomegaly, hypercalcemia, skin lesions, lytic bone lesions, and abnormal peripheral blood film with lymphocytosis and "flower cells"		*Presents with lymphadenopathy, hepatosplenomegaly, hypercalcemia, skin lesions, lytic bone lesions, and abnormal peripheral blood film with lymphocytosis and "flower cells"
	* Skin findings can be either localized or diffuse as papules, nodules, plaques, erythematous patches, and diffuse erythroderma		*Skin findings can be either localized or diffuse as papules, nodules, plaques, erythematous patches, and diffuse erythroderma

	=== HTLV-Associated Myelopathy ===		===HTLV-Associated Myelopathy===

	* Also called '''tropical spastic paraparesis'''		*Also called '''tropical spastic paraparesis'''
	* Associated with HTLV-1 and -2, with lifetime prevalence of 4%		*Associated with HTLV-1 and -2, with lifetime prevalence of 4%
	* Thought to be caused by an autoimmune response from HTLV-1 antibodies due to molecular mimicry		*Thought to be caused by an autoimmune response from HTLV-1 antibodies due to molecular mimicry
	* Chronic progressive demyelinating disease affecting white matter and spinal cord		*Chronic progressive demyelinating disease affecting white matter and spinal cord
	** Unexplained central neurological disease with loss of pyramidal tract		**Unexplained central neurological disease with loss of pyramidal tract
	** Stiff gait progressing to spasticity and weakness, back pain, urinary incontinence, and impotence		**Stiff gait progressing to spasticity and weakness, back pain, urinary incontinence, and impotence
	** Can have parasthesias and burning sensation		**Can have parasthesias and burning sensation
	** Impaired vibration sense		**Impaired vibration sense
	** Hyperreflexia with clonus and upgoing plantar reflexes		**Hyperreflexia with clonus and upgoing plantar reflexes
	* Usually insidious onset, but can be acute		*Usually insidious onset, but can be acute
	* MRI may be normal or show atrophy of the spinal cord and non-specific brain lesions		*MRI may be normal or show atrophy of the spinal cord and non-specific brain lesions
	* CSF can have mild lymphocytosis and mild protein elevation, including oligoclonal bands		*CSF can have mild lymphocytosis and mild protein elevation, including oligoclonal bands

	=== Other Syndromes ===		===Other Syndromes===

	==== HTLV-1 ====		====HTLV-1====

	* Other neurological abnormalities, including sensory neuropathy, gait abnormality, bladder dysfunction, erectile dysfunction, amyotrophic lateral sclerosis, mild cognitive deficit, and motor neuropathy		*Other neurological abnormalities, including sensory neuropathy, gait abnormality, bladder dysfunction, erectile dysfunction, amyotrophic lateral sclerosis, mild cognitive deficit, and motor neuropathy
	* Infective dermatitis, which occurs in children who experience failure to thrive, eczema, and Gram-positive infections		*Infective dermatitis, which occurs in children who experience failure to thrive, eczema, and Gram-positive infections
	* Polymyositis (HTLV-1-associated inflammatory myopathy of skeletal muscle)		*Polymyositis (HTLV-1-associated inflammatory myopathy of skeletal muscle)
	* Large joint polyarthropathy		*Large joint polyarthropathy
	* Uveitis		*Uveitis
	* Infiltrative pneumonitis		*Infiltrative pneumonitis
	* Chronic lympadenopathy		*Chronic lympadenopathy
			*Increased infections:
	* [[Strongyloides]] hyperinfection		**[[Strongyloides]] hyperinfection
	* Crusted [[scabies]]		**Crusted [[scabies]]
			**[[Pneumocystis jirovecii]]
			**[[Mycobacterium avium complex]]

	==== HTLV-2 ====		====HTLV-2====

	* Rarely, HAM and other neurological abnormalities		*Rarely, HAM and other neurological abnormalities

	== Differential Diagnosis ==		==Differential Diagnosis==

	=== HTLV-Associated Myelopathy ===		===HTLV-Associated Myelopathy===

	* [[Multiple sclerosis]], which should have a more waxing-waning course		*[[Multiple sclerosis]], which should have a more waxing-waning course
	* Spinal cord tumour		*Spinal cord tumour
	* Toxic neuropathy		*Toxic neuropathy
	* [[Malnutrition]]		*[[Malnutrition]]
	* [[HIV]]		*[[HIV]]
	* [[Syphilis]]		*[[Syphilis]]

	== Management ==		==Management==

	* Monitoring for signs or symptoms of leukemia, lymphoma, and neurological disease		*Monitoring for signs or symptoms of leukemia, lymphoma, and neurological disease
	* Management of ATL per Hematologi-Oncology service		*Management of ATL per Hematologi-Oncology service

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan: Created page with "== Background == === Microbiology === * Single-stranded negative-sense RNA virus in the Retroviridae family, genus ''Deltaretrovirus'' * Four types: ** HTLV-1, cause of..."

2020-08-14T00:42:50Z

Created page with "== Background == === Microbiology === * Single-stranded negative-sense RNA virus in the Retroviridae family, genus ''Deltaretrovirus'' * Four types: ** HTLV-1, cause of..."

New page

== Background ==

=== Microbiology ===

* Single-stranded negative-sense RNA virus in the [[Retroviridae]] family, genus ''Deltaretrovirus''
* Four types:
** HTLV-1, cause of adult T-cell leukemia-lymphoma and HTLV-associated myelopathy
** HTLV-2, cause of HTLV-associated myelopathy
** HTLV-3 and HTLV-4 are rare

=== Epidemiology ===

* HTLV-1 endemic to central Africa, the Caribbean basin, parts of South America, and southwestern Japan
* HTLV-2 endemic to indigenous people in the Americas, and Central African pygmies, as well as injection drug users in North America and Europe
* Transmitted sexually, parenterally (blood-borne), and vertically (mother-to-child, primarily through breastfeeding)
* Seroprevalence increases with age and is higher in women than men

== Clinical Manifestations ==
{| class="wikitable"
!Syndrome
!HTLV-1
!HTLV-2
|-
! colspan="3" |Children
|-
|Infective dermatitis
|yes
|no
|-
|[[Lymphadenopathy]]
|yes
|yes
|-
! colspan="3" |Adults
|-
|Adult T-cell leukemia-lymphoma
|yes
|no
|-
|HTLV-associated myelopathy
|yes
|yes
|-
|Infective dermatitis
|yes
|no
|-
|[[Polymyositis]]
|possibly
|unknown
|-
|[[Uveitis]]
|yes
|unknown
|-
|HTLV-associated arthritis
|possibly
|possibly
|-
|[[Sjögren syndrome]]
|possibly
|unknown
|-
|[[Strongyloidiasis]]
|possibly
|unknown
|-
|Pulmonary infiltrative pneumonitis
|possibly
|possibly
|-
|Invasive [[cervical cancer]]
|possibly
|unknown
|}

=== Adult T-cell Leukemia-Lymphoma (ATL) ===

* Associated with HTLV-1, with a lifetime risk of 2 to 4% and latent period to 30 to 50 years
* Aggressive T-cell [[leukemia]] or [[lymphoma]] with four subtypes
** Smoldering (5%), with ≥5% abnormal T-cells but otherwise normal differential, ± skin lesions ± pulmonary involvement
** Chronic (19%), with lymphocytosis ≥4 and T-cells >3.5, ± lymphadenopathy/organomegaly/skin lesions/pulmonary involvement
** Lymphoma/leukemia (19%), with lymphadenopathy without lymphocytosis; poor prognosis (median 10 months)
** Acute (57%), with increased leukemic T cells and worsening clinical picture including hypercalcemia; poor prognosis (median 6 months)
* Presents with lymphadenopathy, hepatosplenomegaly, hypercalcemia, skin lesions, lytic bone lesions, and abnormal peripheral blood film with lymphocytosis and "flower cells"
* Skin findings can be either localized or diffuse as papules, nodules, plaques, erythematous patches, and diffuse erythroderma

=== HTLV-Associated Myelopathy ===

* Also called '''tropical spastic paraparesis'''
* Associated with HTLV-1 and -2, with lifetime prevalence of 4%
* Thought to be caused by an autoimmune response from HTLV-1 antibodies due to molecular mimicry
* Chronic progressive demyelinating disease affecting white matter and spinal cord
** Unexplained central neurological disease with loss of pyramidal tract
** Stiff gait progressing to spasticity and weakness, back pain, urinary incontinence, and impotence
** Can have parasthesias and burning sensation
** Impaired vibration sense
** Hyperreflexia with clonus and upgoing plantar reflexes
* Usually insidious onset, but can be acute
* MRI may be normal or show atrophy of the spinal cord and non-specific brain lesions
* CSF can have mild lymphocytosis and mild protein elevation, including oligoclonal bands

=== Other Syndromes ===

==== HTLV-1 ====

* Other neurological abnormalities, including sensory neuropathy, gait abnormality, bladder dysfunction, erectile dysfunction, amyotrophic lateral sclerosis, mild cognitive deficit, and motor neuropathy
* Infective dermatitis, which occurs in children who experience failure to thrive, eczema, and Gram-positive infections
* Polymyositis (HTLV-1-associated inflammatory myopathy of skeletal muscle)
* Large joint polyarthropathy
* Uveitis
* Infiltrative pneumonitis
* Chronic lympadenopathy
* [[Strongyloides]] hyperinfection
* Crusted [[scabies]]

==== HTLV-2 ====

* Rarely, HAM and other neurological abnormalities

== Differential Diagnosis ==

=== HTLV-Associated Myelopathy ===

* [[Multiple sclerosis]], which should have a more waxing-waning course
* Spinal cord tumour
* Toxic neuropathy
* [[Malnutrition]]
* [[HIV]]
* [[Syphilis]]

== Management ==

* Monitoring for signs or symptoms of leukemia, lymphoma, and neurological disease
* Management of ATL per Hematologi-Oncology service

[[Category:Infectious diseases]]
[[Category:Oncology]]
[[Category:Hematology]]
[[Category:Retroviridae]]