Human T-Cell Lymphotropic Viruses Clinical Presentation: History, Physical, Causes

Sections

Sections Human T-Cell Lymphotropic Viruses
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
References

Presentation

History

Acute human T-cell lymphotropic virus (HTLV) infection is rarely suspected or diagnosed.

Because of the low viral replication of HTLV, there are usually no clinical symptoms. Diagnosis may stem from blood donation, testing performed because of a familial history of the infection, or a workup of adult T-cell leukemia (ATL) or HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP) in patients with consistent clinical manifestations. Suspected cases may prompt investigation for a history of a recent blood-product transfusion or a nursing mother from an endemic area.

In considering HTLV infection, the most important historical information pertains to risk assessment. Because detecting accurate seroprevalence in low-endemic populations is inherently problematic, it is important to stratify a patient's risk. Screening enzyme immunoassays (EIAs) yield false-positive results in more than 50% of cases in areas of low prevalence. Therefore, a high-risk individual is anyone who has any of the following characteristics:

Has lived or lives in an endemic area (ie, Japan, the Caribbean, Central or West Africa, South America)
Is a Native American Indian
Has parents or sexual partners from an endemic area
Received blood-product transfusions in the United States before 1988
Has received blood transfusions anywhere that lacks active blood-bank screening
Has a history of injection drug use
Has sexual partners with a history of injection drug use
Has multiple sexual partners and does not use barrier protection
Has strongyloidiasis hyperinfection

The sequelae of latent HTLV infection generally occur decades after the initial infection, with the one exception being the reports of HAM/TSP occurring within a few months of HTLV-1–contaminated blood transfusion.^[40]

Patients with HAM/TSP may present with weakness and stiffness in the lower limbs (first presenting symptom in 60% of cases^[41]), urinary incontinence, and/or severe lower back pain radiating to the legs. In some cases, urinary frequency, urgency, incontinence, or retention precedes the paraparesis by many years. Infected patients may also have symptoms of autonomic dysfunction leading to constipation, and, in some cases, sexual dysfunction.

Symptoms of ATL are clinically broad and can manifest as fatigue, overt lymphadenopathy, thirst (due to hypercalcemia), nausea, vomiting, fever, or abdominal pain.

Physical

There are no strict criteria established in terms of physical findings of HAM/TSP; however, the following constellation of physical findings are typical and progressively worsen:^[27]

Motor and sensory changes in the lower extremities
Clonus (may be evident); involuntary muscular contractions upon stretching of the muscles
Spastic gait in combination with weakness of the lower limbs
Detrusor insufficiency leading to bladder dysfunction
Preserved cognitive and upper-extremity neurological functions

The following isolated neurological symptoms have been also described in patients affected with HTLV-1 or HTLV-2:^[27]

Sensory neuropathies
Gait abnormalities
Bladder dysfunction
Erectile dysfunction
Mild cognitive defects
Motor abnormalities

ATL has the following 4 distinct types and clinical characteristics:

Acute ATL
- Short and aggressive clinical course
- Hypercalcemia, lytic bone lesions, pulmonary involvement, and lymphocytosis
- Hepatosplenomegaly
- Cutaneous lesions (indolent, nodular, indurated, exfoliative, or erythrodermal)
Smoldering ATL
- Abnormal lymphocytes of 5% or less
- Malignant cells with monoclonal proviral integration
- Skin lesions
- Pulmonary involvement (occasional)
- No hypercalcemia, lymphadenopathy, or other visceral involvement
- Possible elevation of the serum lactase dehydrogenase level
Chronic ATL
- No hypercalcemia, ascites, or pleural effusion
- No CNS, bone, or GI involvement
- Possible lymphadenopathy, hepatomegaly, splenomegaly, skin or pulmonary involvement
- A serum lactate dehydrogenase level that may be twice the reference range
- Abnormal T-cell lymphocytes, greater than 3.5 X 10⁹/L
- Absolute lymphocytosis, greater than 4.0 X 10⁹/L
Lymphomatous ATL
- Lymphadenopathy in the absence of lymphocytosis
- Histologic evidence of lymph node involvement required
- Skin lesions clinically indistinguishable from cutaneous T-cell lymphomas

Causes

HTLV-1 and HTLV-2 are transmitted vertically from mother to child via breastfeeding or childbirth, from person to person through sexual contact, and through blood contact, either by transfusion or by reuse of injection equipment.

Blood transfusion is very effective at transmitting HTLV-1 and HTLV-2. Screening is standard policy in the United States and in many other countries. The United States has been screening donated blood since 1988.

Differential Diagnoses

Gallo RC. The discovery of the first human retrovirus: HTLV-1 and HTLV-2. Retrovirology. 2005 Mar 2. 2:17. [Medline]. [Full Text].
Poiesz BJ, Ruscetti FW, Gazdar AF, Bunn PA, Minna JD, Gallo RC. Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma. Proc Natl Acad Sci U S A. 1980 Dec. 77(12):7415-9. [Medline]. [Full Text].
Kalyanaraman VS, Sarngadharan MG, Robert-Guroff M, Miyoshi I, Golde D, Gallo RC. A new subtype of human T-cell leukemia virus (HTLV-II) associated with a T-cell variant of hairy cell leukemia. Science. 1982 Nov 5. 218(4572):571-3. [Medline].
Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC, Murphy EL. Global epidemiology of HTLV-I infection and associated diseases. Oncogene. 2005 Sep 5. 24(39):6058-68. [Medline].
Cook LB, Taylor GP. HTLV-1 and HTLV-2 prevalence in the United States. J Infect Dis. 2014 Feb 15. 209(4):486-7. [Medline].
Manel N, Kim FJ, Kinet S, Taylor N, Sitbon M, Battini JL. The ubiquitous glucose transporter GLUT-1 is a receptor for HTLV. Cell. 2003 Nov 14. 115(4):449-59. [Medline].
Wolfe ND, Heneine W, Carr JK, Garcia AD, Shanmugam V, Tamoufe U. Emergence of unique primate T-lymphotropic viruses among central African bushmeat hunters. Proc Natl Acad Sci U S A. 2005 May 31. 102(22):7994-9. [Medline].
Boxus M, Twizere JC, Legros S, Dewulf JF, Kettmann R, Willems L. The HTLV-1 Tax interactome. Retrovirology. 2008 Aug 14. 5:76. [Medline]. [Full Text].
Takeda S, Maeda M, Morikawa S, et al. Genetic and epigenetic inactivation of tax gene in adult T-cell leukemia cells. Int J Cancer. 2004 Apr 20. 109(4):559-67. [Medline].
Feuer G, Green PL. Comparative biology of human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2. Oncogene. 2005 Sep 5. 24(39):5996-6004. [Medline]. [Full Text].
Lairmore MD, Anupam R, Bowden N, Haines R, Haynes RA 2nd, Ratner L, et al. Molecular determinants of human T-lymphotropic virus type 1 transmission and spread. Viruses. 2011 Jul. 3(7):1131-65. [Medline]. [Full Text].
Matsuoka M, Jeang KT. Human T-cell leukaemia virus type 1 (HTLV-1) infectivity and cellular transformation. Nat Rev Cancer. 2007 Apr. 7(4):270-80. [Medline].
Li HC, Biggar RJ, Miley WJ, Maloney EM, Cranston B, Hanchard B. Provirus load in breast milk and risk of mother-to-child transmission of human T lymphotropic virus type I. J Infect Dis. 2004 Oct 1. 190(7):1275-8. [Medline].
Wiktor SZ, Pate EJ, Rosenberg PS, Barnett M, Palmer P, Medeiros D. Mother-to-child transmission of human T-cell lymphotropic virus type I associated with prolonged breast-feeding. J Hum Virol. 1997 Nov-Dec. 1(1):37-44. [Medline].
Kinoshita K, Amagasaki T, Hino S, et al. Milk-borne transmission of HTLV-I from carrier mothers to their children. Jpn J Cancer Res. 1987 Jul. 78(7):674-80. [Medline].
Roucoux DF, Murphy EL. The epidemiology and disease outcomes of human T-lymphotropic virus type II. AIDS Rev. 2004 Jul-Sep. 6(3):144-54. [Medline].
Manns A, Wilks RJ, Murphy EL, et al. A prospective study of transmission by transfusion of HTLV-I and risk factors associated with seroconversion. Int J Cancer. 1992 Jul 30. 51(6):886-91. [Medline].
Yara S, Fujita J, Date H. Transmission of human T-lymphotropic virus type I by bilateral living-donor lobar lung transplantation. J Thorac Cardiovasc Surg. 2009 Jul. 138(1):255-6. [Medline].
Zunt JR, Tapia K, Thiede H, Lee R, Hagan H. HTLV-2 infection in injection drug users in King County, Washington. Scand J Infect Dis. 2006. 38(8):654-63. [Medline]. [Full Text].
Lins L, de Carvalho VJ, de Almeida Rego FF, Azevedo R, Kashima S, Gallazi VN, et al. Oral health profile in patients infected with HTLV-1: clinical findings, proviral load, and molecular analysis from HTLV-1 in saliva. J Med Virol. 2012 Sep. 84(9):1428-36. [Medline].
Murata M, Mizusawa H, Kanazawa I, Yazawa T, Uchida Y. [An autopsy case of HTLV-I associated myelopathy (HAM) with adult T-cell leukemia (ATL)]. Rinsho Shinkeigaku. 1990 Jul. 30(7):754-9. [Medline].
Furukawa Y, Okadome T, Tara M, Niina K, Izumo S, Osame M. Human T-cell lymphotropic virus type-I (HTLV-I)-associated myelopathy/tropical spastic paraparesis with acute type of adult T-cell leukemia. Intern Med. 1995 Nov. 34(11):1130-3. [Medline].
Murphy EL, Biswas HH. Human T-cell lymphotropic virus types I and II. Mandell G, Bennett J, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Churchill Livingston / Elsevier; 2010. Ch 168.
Shimoyama M. Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. A report from the Lymphoma Study Group (1984-87). Br J Haematol. 1991 Nov. 79(3):428-37. [Medline].
Alberti C, Gonzalez J, Maldonado H, et al. Comparative study of CSF neurofilaments in HTLV-1-associated myelopathy/tropical spastic paraparesis and other neurological disorders. AIDS Res Hum Retroviruses. 2009 Aug. 25(8):803-9. [Medline].
Primo J, Siqueira I, Nascimento MC, et al. High HTLV-1 proviral load, a marker for HTLV-1 associated myelopathy/tropical spastic paraparesis, is also detected in patients with infective dermatitis associated with HTLV-1. Braz J Med Biol Res. 2009 Aug. 42(8):761-4. [Medline].
Biswas HH, Engstrom JW, Kaidarova Z, et al. Neurologic abnormalities in HTLV-I- and HTLV-II-infected individuals without overt myelopathy. Neurology. 2009 Sep 8. 73(10):781-9. [Medline]. [Full Text].
Buggage RR. Ocular manifestations of human T-cell lymphotropic virus type 1 infection. Curr Opin Ophthalmol. 2003 Dec. 14(6):420-5. [Medline].
Maruyama K, Nagata K, Kojima K, Inaba T, Sugita S, Mochizuki M, et al. Intraocular Invasion of Adult T-Cell Leukemia Cells without Systemic Symptoms after Cataract Surgery. Case Rep Ophthalmol. 2013. 4(3):252-6. [Medline]. [Full Text].
Yazdanpanah MJ, Maleki M, Joneidi N, Khalighi AR, Azarpazhooh MR, Khajedaluee M, et al. Cutaneous Manifestations in HTLV-I Positive Blood Donors. Iran J Basic Med Sci. 2013 Mar. 16(3):273-7. [Medline]. [Full Text].
Nishioka K, Maruyama I, Sato K, Kitajima I, Nakajima Y, Osame M. Chronic inflammatory arthropathy associated with HTLV-I. Lancet. 1989 Feb 25. 1(8635):441. [Medline].
Martins FM, Casseb J, Penalva-de-Oliveira AC, de Paiva MF, Watanuki F, Ortega KL. Oral manifestations of human T-cell lymphotropic virus infection in adult patients from Brazil. Oral Dis. 2010 Mar. 16(2):167-71. [Medline].
Garlet GP, Giozza SP, Silveira EM, Claudino M, Santos SB, Avila-Campos MJ, et al. Association of human T lymphotropic virus 1 amplification of periodontitis severity with altered cytokine expression in response to a standard periodontopathogen infection. Clin Infect Dis. 2010 Feb 1. 50(3):e11-8. [Medline].
Dooneief G, Marlink R, Bell K, et al. Neurologic consequences of HTLV-II infection in injection-drug users. Neurology. 1996 Jun. 46(6):1556-60. [Medline].
Calattini S, Chevalier SA, Duprez R, Bassot S, Froment A, Mahieux R. Discovery of a new human T-cell lymphotropic virus (HTLV-3) in Central Africa. Retrovirology. 2005. 2:30. [Medline].
Perzova R, Benz P, Abbott L, Welch C, Thomas A, El Ghoul R, et al. Short communication: no evidence of HTLV-3 and HTLV-4 infection in New York State subjects at risk for retroviral infection. AIDS Res Hum Retroviruses. 2010 Nov. 26(11):1229-31. [Medline].
Chang YB, Kaidarova Z, Hindes D, Bravo M, Kiely N, Kamel H, et al. Seroprevalence and demographic determinants of human T-lymphotropic virus type 1 and 2 infections among first-time blood donors--United States, 2000-2009. J Infect Dis. 2014 Feb 15. 209(4):523-31. [Medline]. [Full Text].
Yasunaga J, Matsuoka M. Human T-cell leukemia virus type I induces adult T-cell leukemia: from clinical aspects to molecular mechanisms. Cancer Control. 2007 Apr. 14(2):133-40. [Medline].
Eshima N, Iwata O, Iwata S, et al. Age and gender specific prevalence of HTLV-1. J Clin Virol. 2009 Jun. 45(2):135-8. [Medline].
Gout O, Baulac M, Gessain A, et al. Rapid development of myelopathy after HTLV-I infection acquired by transfusion during cardiac transplantation. N Engl J Med. 1990 Feb 8. 322(6):383-8. [Medline].
Cooper SA, van der Loeff MS, Taylor GP. The neurology of HTLV-1 infection. Pract Neurol. 2009 Feb. 9(1):16-26. [Medline].
Tsukasaki K, Hermine O, Bazarbachi A, et al. Definition, prognostic factors, treatment, and response criteria of adult T-cell leukemia-lymphoma: a proposal from an international consensus meeting. J Clin Oncol. 2009 Jan 20. 27(3):453-9. [Medline]. [Full Text].
[Guideline] Khabbaz RF, Fukuda K, Kaplan JE. Guidelines for counseling human T-lymphotropic virus type I (HTLV-I)- and HTLV type II-infected persons. Transfusion. 1993 Aug. 33(8):694. [Medline].
Ramos JC, Lossos IS. Newly emerging therapies targeting viral-related lymphomas. Curr Oncol Rep. 2011 Oct. 13(5):416-26. [Medline].
Yamauchi J, Coler-Reilly A, Sato T, Araya N, Yagishita N, Ando H, et al. Anti-CCR4 antibody mogamulizumab targets human T-lymphotropic virus type I-infected CD8+ as well as CD4+ T cells to treat associated myelopathy. J Infect Dis. 2014 Aug 7. [Medline].
Miyamura F, Kako S, Yamagami H, et al. Successful treatment of young-onset adult T cell leukemia/lymphoma and preceding chronic refractory eczema and corneal injury by allogeneic hematopoietic stem cell transplantation. Int J Hematol. 2009 Aug 25. [Medline].
Willems L. The 14th International Conference on Human Retrovirology: HTLV and related retroviruses (July 1-4, 2009; Salvador, Brazil). Retrovirology. 2009 Aug 17. 6:77. [Medline]. [Full Text].
Macchi B, Balestrieri E, Mastino A. Effects of nucleoside-based antiretroviral chemotherapy on human T cell leukaemia/lymphotropic virus type 1 (HTLV-1) infection in vitro. J Antimicrob Chemother. 2003 Jun. 51(6):1327-30. [Medline].
Carvalho EM, Da Fonseca Porto A. Epidemiological and clinical interaction between HTLV-1 and Strongyloides stercoralis. Parasite Immunol. 2004 Nov-Dec. 26(11-12):487-97. [Medline].
Collins JA, Hernandez AV, Hidalgo JA, Salazar R. HTLV-I infection is not associated with a higher risk of death in Peruvian HIV-infected patients. Rev Inst Med Trop Sao Paulo. 2009 Jul-Aug. 51(4):197-201. [Medline].
Brites C, Sampalo J, Oliveira A. HIV/human T-cell lymphotropic virus coinfection revisited: impact on AIDS progression. AIDS Rev. 2009 Jan-Mar. 11(1):8-16. [Medline].
Andrade TM, Dourado I, Galvao-Castro B. Associations among HTLV-I, HTLV-II, and HIV in injecting drug users in Salvador, Brazil. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Jun 1. 18(2):186-7. [Medline].
Aye MM, Matsuoka E, Moritoyo T, et al. Histopathological analysis of four autopsy cases of HTLV-I-associated myelopathy/tropical spastic paraparesis: inflammatory changes occur simultaneously in the entire central nervous system. Acta Neuropathol. 2000 Sep. 100(3):245-52. [Medline].
Beilke MA, Japa S, Moeller-Hadi C, Martin-Schild S. Tropical spastic paraparesis/human T leukemia virus type 1-associated myelopathy in HIV type 1-coinfected patients. Clin Infect Dis. 2005 Sep 15. 41(6):e57-63. [Medline].
Berger JR, Svenningsson A, Raffanti S, Resnick L. Tropical spastic paraparesis-like illness occurring in a patient dually infected with HIV-1 and HTLV-II. Neurology. 1991 Jan. 41(1):85-7. [Medline].
Borg A, Yin JA, Johnson PR, Tosswill J, Saunders M, Morris D. Successful treatment of HTLV-1-associated acute adult T-cell leukaemia lymphoma by allogeneic bone marrow transplantation. Br J Haematol. 1996 Sep. 94(4):713-5. [Medline].
Castilla J, Pachon I, Gonzalez MP, et al. Seroprevalence of HIV and HTLV in a representative sample of the Spanish population. Epidemiol Infect. 2000 Aug. 125(1):159-62. [Medline].
Cavrois M, Gessain A, Gout O, Wain-Hobson S, Wattel E. Common human T cell leukemia virus type 1 (HTLV-1) integration sites in cerebrospinal fluid and blood lymphocytes of patients with HTLV-1-associated myelopathy/tropical spastic paraparesis indicate that HTLV-1 crosses the blood-brain barrier via clonal HTLV-1-infected cells. J Infect Dis. 2000 Oct. 182(4):1044-50. [Medline].
Edlich RF, Arnette JA, Williams FM. Global epidemic of human T-cell lymphotropic virus type-I (HTLV-I). J Emerg Med. 2000 Jan. 18(1):109-19. [Medline].
Gessain A, Barin F, Vernant JC, et al. Antibodies to human T-lymphotropic virus type-I in patients with tropical spastic paraparesis. Lancet. 1985 Aug 24. 2(8452):407-10. [Medline].
Grassmann R, Berchtold S, Radant I, Alt M, Fleckenstein B, Sodroski JG. Role of human T-cell leukemia virus type 1 X region proteins in immortalization of primary human lymphocytes in culture. J Virol. 1992 Jul. 66(7):4570-5. [Medline]. [Full Text].
Hall WW, Takahashi H, Liu C, Kaplan MH, Scheewind O, Ijichi S. Multiple isolates and characteristics of human T-cell leukemia virus type II. J Virol. 1992 Apr. 66(4):2456-63. [Medline]. [Full Text].
Haoudi A, Daniels RC, Wong E, Kupfer G, Semmes OJ. Human T-cell leukemia virus-I tax oncoprotein functionally targets a subnuclear complex involved in cellular DNA damage-response. J Biol Chem. 2003 Sep 26. 278(39):37736-44. [Medline].
Hershow RC, Galai N, Fukuda K, Graber J, Vlahov D, Rezza G. An international collaborative study of the effects of coinfection with human T-lymphotropic virus type II on human immunodeficiency virus type 1 disease progression in injection drug users. J Infect Dis. 1996 Aug. 174(2):309-17. [Medline].
Hinuma Y, Nagata K, Hanaoka M, Nakai M, Matsumoto T, Kinoshita KI. Adult T-cell leukemia: antigen in an ATL cell line and detection of antibodies to the antigen in human sera. Proc Natl Acad Sci U S A. 1981 Oct. 78(10):6476-80. [Medline]. [Full Text].
Hisada M, Maloney EM, Sawada T, Miley WJ, Palmer P, Hanchard B. Virus markers associated with vertical transmission of human T lymphotropic virus type 1 in Jamaica. Clin Infect Dis. 2002 Jun 15. 34(12):1551-7. [Medline].
Hjelle B, Zhu SW, Takahashi H, Ijichi S, Hall WW. Endemic human T cell leukemia virus type II infection in southwestern US Indians involves two prototype variants of virus. J Infect Dis. 1993 Sep. 168(3):737-40. [Medline].
Iga M, Okayama A, Stuver S, Matsuoka M, Mueller N, Aoki M. Genetic evidence of transmission of human T cell lymphotropic virus type 1 between spouses. J Infect Dis. 2002 Mar 1. 185(5):691-5. [Medline].
Igakura T, Stinchcombe JC, Goon PK, Taylor GP, Weber JN, Griffiths GM. Spread of HTLV-I between lymphocytes by virus-induced polarization of the cytoskeleton. Science. 2003 Mar 14. 299(5613):1713-6. [Medline].
Jeang KT. Functional activities of the human T-cell leukemia virus type I Tax oncoprotein: cellular signaling through NF-kappa B. Cytokine Growth Factor Rev. 2001 Jun-Sep. 12(2-3):207-17. [Medline].
Jeffery KJ, Usuku K, Hall SE, Matsumoto W, Taylor GP, Procter J. HLA alleles determine human T-lymphotropic virus-I (HTLV-I) proviral load and the risk of HTLV-I-associated myelopathy. Proc Natl Acad Sci U S A. 1999 Mar 30. 96(7):3848-53. [Medline].
Kannagi M, Ohashi T, Harashima N, Hanabuchi S, Hasegawa A. Immunological risks of adult T-cell leukemia at primary HTLV-I infection. Trends Microbiol. 2004 Jul. 12(7):346-52. [Medline].
LaGrenade L, Hanchard B, Fletcher V, Cranston B, Blattner W. Infective dermatitis of Jamaican children: a marker for HTLV-I infection. Lancet. 1990 Dec 1. 336(8727):1345-7. [Medline].
Lee HH, Weiss SH, Brown LS, Mildvan D, Shorty V, Saravolatz L. Patterns of HIV-1 and HTLV-I/II in intravenous drug abusers from the middle atlantic and central regions of the USA. J Infect Dis. 1990 Aug. 162(2):347-52. [Medline].
Lezin A, Olindo S, Oliere S, et al. Human T lymphotropic virus type I (HTLV-I) proviral load in cerebrospinal fluid: a new criterion for the diagnosis of HTLV-I-associated myelopathy/tropical spastic paraparesis?. J Infect Dis. 2005 Jun 1. 191(11):1830-4. [Medline].
Loughran TP Jr, Coyle T, Sherman MP, et al. Detection of human T-cell leukemia/lymphoma virus, type II, in a patient with large granular lymphocyte leukemia. Blood. 1992 Sep 1. 80(5):1116-9. [Medline].
Marcos LA, Terashima A, Dupont HL, Gotuzzo E. Strongyloides hyperinfection syndrome: an emerging global infectious disease. Trans R Soc Trop Med Hyg. 2008 Apr. 102(4):314-8. [Medline].
Martin MP, Biggar RJ, Hamlin-Green G, Staal S, Mann D. Large granular lymphocytosis in a patient infected with HTLV-II. AIDS Res Hum Retroviruses. 1993 Aug. 9(8):715-9. [Medline].
Matsuoka M. Human T-cell leukemia virus type I (HTLV-I) infection and the onset of adult T-cell leukemia (ATL). Retrovirology. 2005. 2:27. [Medline].
Melo J, Beby-Defaux A, Faria C, et al. HIV and HTLV prevalences among women seen for sexually transmitted diseases or pregnancy follow-up in Maputo, Mozambique. J Acquir Immune Defic Syndr. 2000 Feb 1. 23(2):203-4. [Medline].
Mori N, Yamada Y, Ikeda S, Yamasaki Y, Tsukasaki K, Tanaka Y. Bay 11-7082 inhibits transcription factor NF-kappaB and induces apoptosis of HTLV-I-infected T-cell lines and primary adult T-cell leukemia cells. Blood. 2002 Sep 1. 100(5):1828-34. [Medline].
Murphy EL, Mahieux R, de The G, et al. Molecular epidemiology of HTLV-II among United States blood donors and intravenous drug users: an age-cohort effect for HTLV-II RFLP type aO. Virology. 1998 Mar 15. 242(2):425-34. [Medline].
Murphy EL, Wang B, Sacher RA, Fridey J, Smith JW, Nass CC. Respiratory and urinary tract infections, arthritis, and asthma associated with HTLV-I and HTLV-II infection. Emerg Infect Dis. 2004 Jan. 10(1):109-16. [Medline].
Murphy EL, Watanabe K, Nass CC, Ownby H, Williams A, Nemo G. Evidence among blood donors for a 30-year-old epidemic of human T lymphotropic virus type II infection in the United States. J Infect Dis. 1999 Dec. 180(6):1777-83. [Medline].
Nasr R, El-Sabban ME, Karam JA, et al. Efficacy and mechanism of action of the proteasome inhibitor PS-341 in T-cell lymphomas and HTLV-I associated adult T-cell leukemia/lymphoma. Oncogene. 2005 Jan 13. 24(3):419-30. [Medline].
Ohashi T, Hanabuchi S, Kato H, Tateno H, Takemura F, Tsukahara T. Prevention of adult T-cell leukemia-like lymphoproliferative disease in rats by adoptively transferred T cells from a donor immunized with human T-cell leukemia virus type 1 Tax-coding DNA vaccine. J Virol. 2000 Oct. 74(20):9610-6. [Medline].
Orland JR, Wang B, Wright DJ, Nass CC, Garratty G, Smith JW. Increased mortality associated with HTLV-II infection in blood donors: a prospective cohort study. Retrovirology. 2004. 1:4. [Medline]. [Full Text].
Osame M, Usuku K, Izumo S, Ijichi N, Amitani H, Igata A. HTLV-I associated myelopathy, a new clinical entity. Lancet. 1986 May 3. 1(8488):1031-2. [Medline].
Pawson R, Schulz TF, Matutes E, Catovsky D. The human T-cell lymphotropic viruses types I/II are not involved in T prolymphocytic leukemia and large granular lymphocytic leukemia. Leukemia. 1997 Aug. 11(8):1305-11. [Medline].
Poiesz B, Dube D, Dube S, et al. HTLV-II-associated cutaneous T-cell lymphoma in a patient with HIV-1 infection. N Engl J Med. 2000 Mar 30. 342(13):930-6. [Medline].
Portis T, Harding JC, Ratner L. The contribution of NF-kappa B activity to spontaneous proliferation and resistance to apoptosis in human T-cell leukemia virus type 1 Tax-induced tumors. Blood. 2001 Aug 15. 98(4):1200-8. [Medline].
Porto AF, Santos SB, Muniz AL, Basilio V, Rodrigues W Jr, Neva FA. Helminthic infection down-regulates type 1 immune responses in human T cell lymphotropic virus type 1 (HTLV-1) carriers and is more prevalent in HTLV-1 carriers than in patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. J Infect Dis. 2005 Feb 15. 191(4):612-8. [Medline].
Primo JR, Brites C, Oliveira Mde F, Moreno-Carvalho O, Machado M, Bittencourt AL. Infective dermatitis and human T cell lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis in childhood and adolescence. Clin Infect Dis. 2005 Aug 15. 41(4):535-41. [Medline].
Rosenblatt JD, Giorgi JV, Golde DW, et al. Integrated human T-cell leukemia virus II genome in CD8 + T cells from a patient with "atypical" hairy cell leukemia: evidence for distinct T and B cell lymphoproliferative disorders. Blood. 1988 Feb. 71(2):363-9. [Medline].
Roucoux DF, Wang B, Smith D, et al. A prospective study of sexual transmission of human T lymphotropic virus (HTLV)-I and HTLV-II. J Infect Dis. 2005 May 1. 191(9):1490-7. [Medline].
Rous P. Landmark article (JAMA 1911;56:198). Transmission of a malignant new growth by means of a cell-free filtrate. By Peyton Rous. JAMA. 1983 Sep 16. 250(11):1445-9. [Medline].
Safaeian M, Wilson LE, Taylor E, Thomas DL, Vlahov D. HTLV-II and bacterial infections among injection drug users. J Acquir Immune Defic Syndr. 2000 Aug 15. 24(5):483-7. [Medline].
Salemi M, Lewis M, Egan JF, Hall WW, Desmyter J, Vandamme AM. Different population dynamics of human T cell lymphotropic virus type II in intravenous drug users compared with endemically infected tribes. Proc Natl Acad Sci U S A. 1999 Nov 9. 96(23):13253-8. [Medline]. [Full Text].
Seiki M, Hattori S, Yoshida M. Human adult T-cell leukemia virus: molecular cloning of the provirus DNA and the unique terminal structure. Proc Natl Acad Sci U S A. 1982 Nov. 79(22):6899-902. [Medline]. [Full Text].
Shuh M, Beilke M. The human T-cell leukemia virus type 1 (HTLV-1): new insights into the clinical aspects and molecular pathogenesis of adult T-cell leukemia/lymphoma (ATLL) and tropical spastic paraparesis/HTLV-associated myelopathy (TSP/HAM). Microsc Res Tech. 2005 Nov. 68(3-4):176-96. [Medline].
Tajima K. Worldwide distribution of HTLV. Jpn J Cancer Res. 1998 Jan. 89(1):inside front cover. [Medline].
Taylor GP, Matsuoka M. Natural history of adult T-cell leukemia/lymphoma and approaches to therapy. Oncogene. 2005 Sep 5. 24(39):6047-57. [Medline].
Telzak EE, Hershow R, Kalish LA, et al. Seroprevalence of HTLV-I and HTLV-II among a cohort of HIV-infected women and women at risk for HIV infection. Women's Interagency HIV Study. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Dec 15. 19(5):513-8. [Medline].
Temin HM, Mizutani S. RNA-dependent DNA polymerase in virions of Rous sarcoma virus. Nature. 1970 Jun 27. 226(5252):1211-3. [Medline].
Tsukasaki K, Maeda T, Arimura K, Taguchi J, Fukushima T, Miyazaki Y. Poor outcome of autologous stem cell transplantation for adult T cell leukemia/lymphoma: a case report and review of the literature. Bone Marrow Transplant. 1999 Jan. 23(1):87-9. [Medline].
Uchiyama T, Yodoi J, Sagawa K, Takatsuki K, Uchino H. Adult T-cell leukemia: clinical and hematologic features of 16 cases. Blood. 1977 Sep. 50(3):481-92. [Medline].
Utsunomiya A, Miyazaki Y, Takatsuka Y, Hanada S, Uozumi K, Yashiki S. Improved outcome of adult T cell leukemia/lymphoma with allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001 Jan. 27(1):15-20. [Medline].
Vine AM, Witkover AD, Lloyd AL, Jeffery KJ, Siddiqui A, Marshall SE. Polygenic control of human T lymphotropic virus type I (HTLV-I) provirus load and the risk of HTLV-I-associated myelopathy/tropical spastic paraparesis. J Infect Dis. 2002 Oct 1. 186(7):932-9. [Medline].
Waldmann TA, White JD, Goldman CK, Top L, Grant A, Bamford R. The interleukin-2 receptor: a target for monoclonal antibody treatment of human T-cell lymphotrophic virus I-induced adult T-cell leukemia. Blood. 1993 Sep 15. 82(6):1701-12. [Medline].
Yoshida M. Multiple viral strategies of HTLV-1 for dysregulation of cell growth control. Annu Rev Immunol. 2001. 19:475-96. [Medline].
Zhang Z, Zhang M, Ravetch JV, Goldman C, Waldmann TA. Effective therapy for a murine model of adult T-cell leukemia with the humanized anti-CD2 monoclonal antibody, MEDI-507. Blood. 2003 Jul 1. 102(1):284-8. [Medline].

Media Gallery

of 0

Author

Ewa Maria Szczypinska, MD Fellow, Department of Infectious Diseases, Orlando Health

Ewa Maria Szczypinska, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Booth Wainscoat, DO Assistant Director, Division of Infectious Disease, Hartford Hospital; Assistant Professor of Clinical Medicine, University of Connecticut School of Medicine

Booth Wainscoat, DO is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Received consulting fee from Gilead for consulting.

Christopher Mark Salas, MD Fellow, Department of Infectious Diseases, Lifespan, The Warren Alpert Medical School of Brown University

Disclosure: Nothing to disclose.

Josiah D Rich, MD, MPH Professor of Medicine and Epidemiology, Brown University Medical School

Josiah D Rich, MD, MPH is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Medical Association, American Public Health Association, Infectious Diseases Society of America, Massachusetts Medical Society, Rhode Island Medical Society

Disclosure: Received ownership interest from alkermes stockholder for none; Received ownership interest from isis stockholder for none; Received ownership interest from repligen for none.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, Infectious Diseases Society of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Joseph R Masci, MD, FACP, FCCP Professor of Medicine, Professor of Preventive Medicine, Icahn School of Medicine at Mount Sinai; Director of Medicine, Elmhurst Hospital Center

Joseph R Masci, MD, FACP, FCCP is a member of the following medical societies: American Association for the Advancement of Science, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International AIDS Society, International Society for Infectious Diseases, New York Academy of Medicine, New York Academy of Sciences, Physicians for Social Responsibility, Royal Society of Medicine, Association of Program Directors in Internal Medicine, Physicians for Human Rights, Association of Professors of Medicine, HIV Medicine Association, American Academy of HIV Medicine, Association of Specialty Professors, International Association of Providers of AIDS Care, Federation of American Scientists, American Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Sections Human T-Cell Lymphotropic Viruses
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
References

Human T-Cell Lymphotropic Viruses Clinical Presentation

History

Physical

Causes

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Human T-Cell Lymphotropic Viruses Clinical Presentation

History

Physical

Causes

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Related Conditions and Diseases

Medscape Consult

News & Perspective

Tools

Most Popular Articles

Recommended