Late presentation of human T-lymphotropic virus type 1 infection in Spain reflects suboptimal testing strategies.
Por:
de Mendoza C, Pérez L, Fernández-Ruiz M, Pena MJ, Ramos JM, Richart A, Piron M, Rando A, Miró E, Reina G, Encinas B, Rojo S, Rodriguez-Iglesias AM, Benito R, Aguilera A, Treviño A, Corral O and Soriano V
Publicada:
1 sep 2022
Ahead of Print:
25 jul 2022
Resumen:
OBJECTIVES: Although only 10% of persons infected with human T-lymphotropic virus type 1 (HTLV-1) may develop virus-associated illnesses over their lifetime, missing the earlier diagnosis of asymptomatic carriers frequently leads to late presentation. METHODS: A nationwide HTLV-1 register was created in Spain in 1989. We examined the main demographics and clinical features at the time of the first diagnosis for more than three decades. RESULTS: A total of 428 individuals infected with HTLV-1 had been reported in Spain until the end of 2021. Up to 96 (22%) individuals presented clinically with HTLV-1-associated conditions, including subacute myelopathy (57%), T-cell lymphoma (34%), or Strongyloides stercoralis infestation (8%). Since 2008, HTLV-1 diagnosis has been made at blood banks (44%) or clinics (56%). Native Spaniards and Sub-Saharan Africans are overrepresented among patients presenting with HTLV-1-associated illnesses suggesting that poor epidemiological and/or clinical suspicion, which led to the late presentation are more frequent in them than carriers from Latin America (LATAM) (31.7% vs 20.4%, respectively; P = 0.015). CONCLUSION: HTLV-1 infection in Spain is frequently diagnosed in patients presenting with characteristic illnesses. Although screening in blood banks mostly identifies asymptomatic carriers from LATAM, a disproportionately high number of Spaniards and Africans are diagnosed too late at the time of clinical manifestations. Expanding testing to all pregnant women and clinics for sexually transmitted infections could help to unveil HTLV-1 asymptomatic carriers.
Filiaciones:
de Mendoza C:
Internal Medicine Laboratory, Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
Pérez L:
Internal Medicine Department, Gregorio Marañon University Hospital, Madrid, Spain
Fernández-Ruiz M:
Infectious Diseases Unit, 12 Octubre University Hospital, Madrid, Spain
Pena MJ:
Microbiology Department, Doctor Negrín University Hospital, Las Palmas de Gran Canaria, Spain
:
Infectious Diseases Unit, Alicante General University Hospital, Alicante, Spain
Richart A:
Regional Transfusion Center, Madrid, Spain
Piron M:
Catalan Tissue & Blood Bank, Barcelona, Spain
Rando A:
Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
Miró E:
Microbiology Department, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
Reina G:
Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
Encinas B:
Internal Medicine Laboratory, Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
Rojo S:
Microbiology Department, Hospital Clínico Universitario, Valladolid, Spain
Rodriguez-Iglesias AM:
Microbiology Department, University of Cadiz, Cadiz, Spain
Benito R:
Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
Aguilera A:
Microbiology Department, University of Santiago, Santiago de Compostela, Spain
Treviño A:
UNIR Health Sciences School & Medical Center, Madrid, Spain
Corral O:
UNIR Health Sciences School & Medical Center, Madrid, Spain
Soriano V:
UNIR Health Sciences School & Medical Center, Madrid, Spain
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