II. Epidemiology

  1. Worldwide Prevalence: 5-10 Million
  2. Primarily found in Caribbean islands and Japan

III. Pathophysiology

  1. Human T-lymphotropic virus type 1 (HTLV-1) is a Retrovirus similar to HIV
    1. Results in life-long infection characterized by Immunosuppression and multi-system disease
    2. HTLV-1 was the first identified Retrovirus in humans (initially discovered in T Cell Leukemia patients)
  2. Transmission
    1. Breast Feeding (20-30% transmission rates)
    2. Sexual contact
    3. Bloodborne (needle sharing, contaminated Blood Transfusion)

IV. Findings

  1. Asymptomatic in >90% of patients
  2. Common presentations
    1. Uveitis
    2. Dermatitis
    3. Pneumonitis

V. Labs: Diagnosis

  1. HTLV1 Antibody via enzyme-linked immunoassay
    1. Requires second confirmatory test (e.g. Western Blot, PCR)

VI. Complications

  1. Adult T-cell Leukemia or Lymphoma
  2. Opportunistic Infections
  3. Progressive neurologic disorders (HAM or TSP)
    1. Two condition names for the same disorder
      1. HTLV-1 associated Myelopathy (HAM, 5% lifetime Prevalence in HTLV1 infection)
      2. Tropical spastic paraparesis (TSP, 2% lifetime Prevalence in HTLV1 infection)
    2. Findings
      1. Progressive spastic weakness of the lower limbs
      2. Lower back pain
      3. Spastic gait
      4. Hyperreflexia
      5. Bowel and Bladder dysfunction

VII. Management

  1. No current specific treatment is available
  2. Symptomatic management
  3. Corticosteroids, immunomodulators and chemotherapeutic agents are used

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