HIV-1 and HTLV-1 Transmission Modes: Mechanisms and Importance for Virus Spread

So far, only two retroviruses, human immunodeficiency virus (HIV) (type 1 and 2) and human T-cell lymphotropic virus type 1 (HTLV-1), have been recognized as pathogenic for humans. Both viruses mainly infect CD4+ T lymphocytes. HIV replication induces the apoptosis of CD4 lymphocytes, leading to the development of acquired immunodeficiency syndrome (AIDS). After a long clinical latency period, HTLV-1 can transform lymphocytes, with subsequent uncontrolled proliferation and the manifestation of a disease called adult T-cell leukemia (ATLL). Certain infected patients develop neurological autoimmune disorder called HTLV-1-associated myelopathy, also known as tropical spastic paraparesis (HAM/TSP). Both viruses are transmitted between individuals via blood transfusion, tissue/organ transplantation, breastfeeding, and sexual intercourse. Within the host, these viruses can spread utilizing either cell-free or cell-to-cell modes of transmission. In this review, we discuss the mechanisms and importance of each mode of transmission for the biology of HIV-1 and HTLV-1.

Surgical removal of a compressive thoracic epidural vascular malformation in a patient with Klippel-Trénaunay syndrome: illustrative case

BACKGROUND Klippel-Trénaunay syndrome (KTS) is a combined capillary-lymphatic-venous malformation disorder traditionally associated with high surgical morbidity. Although rare, pathologic involvement of the spinal cord has been reported in the literature. However, the safety of surgical intervention remains unclear. We report a case of successful decompression of a thoracic epidural lesion in an individual with KTS who presented with spastic paraparesis. OBSERVATIONS The patient is a 38-year-old male, diagnosed with KTS as an infant, who presented with spastic paraparesis secondary to a thoracic epidural lesion. He underwent laminectomies and resection of the lesion with subsequent improvement of his symptoms and without significant postoperative morbidity. Histopathology confirmed the lesion to be a benign vascular malformation. LESSONS Currently, the literature regarding management of symptomatic vascular lesions in individuals with KTS supports nonoperative management, due to the increased risk of operative morbidity associated with this syndrome. This case presents evidence for safe and appropriate surgical management of a thoracic epidural vascular malformation in a patient with KTS in the setting of progressive neurological decline, establishing a role for neurosurgical intervention in this high-risk population when no conservative management portends further neurological deterioration.

Dorsal spine intradural extramedullary hemangiopericytoma: a case report

Introduction: Hemangiopericytomas are rare CNS Neoplasms constituting <1% of CNS tumours. They are more commonly seen in cranium than in spine where they present as Intradural extramedullary in location. They rarely metastasize to Lung and Bone.World Health Organization Classification of Tumors of the Central Nervous System (CNS WHO) assigned the combined term solitary fibrous tumor/ hemangiopericytoma (SFT/HPC) to such lesions in 2016 due to their same genetic makeup. Case report: Our case is about a 61-year-old diabetic male who presented with insidious onset, gradually progressive thoracic backache and asymmetric weakness with tightness and numbness of both lower limbs for last 6 months with no sphincter incontinence and bed bound for last 15 days. Clinically he had asymmetric spastic paraparesis of lower limb. His MRI Dorsal spine showed a 1.5 ґ 2 cm heterogeneously contrast enhancing Intradural lesion at D6-D7 compressing the cord from dorsolaterally with extensive cord edema from C5 to L2. Preoperative diagnosis of Meningioma/ Metastasis was made and patient underwentD5-D7 laminectomy and tumour excision. Intraoperative findings, there was no dural attachment, there were multiple tortuous blood vessels overlying greyish pink, fleshy, suckable, highly vascular, capsulated tumor posterolateral to cord. The superior aspect of tumor was adherent to cord with no clear interface. Tumor was seen separate from Left D7 nerve root. Post operatively patient improved symptomatically and neurologically. His HPE was suggestive of Hemangiopericytoma WHO Grade II (IHC markers CD34 and CD 31 was positive and KI 67% index of 10-15%). Patient has been on follow up and planned for metastatic workup. Conclusion: Spinal Hemangiopericytoma are rare disease with nonspecific radiological features making preoperative diagnosis difficult. Differential diagnosis of hemangiopericytoma should be kept in case of atypical and high - grade radiological features. Gross total resection without compromising the neurological status should be the goal to prevent local recurrence. Proper consensus regarding the follow up and adjuvant therapies of spinal Hemangiopericytoma are still lacking.

Computed tomography with 6-year follow-up demonstrates the evolution of HTLV-1 related lung injuries: A cohort study

Previous observational studies have demonstrated the development of pulmonary impairments in human T-lymphotropic virus type 1 (HTLV-1) infected individuals. The main observed lesions due to chronic inflammation of viral infection in situ are bronchiectasis and lung-scarring injuries. This lung inflammation may be the causal agent of restrictive and obstructive lung diseases, primarily in tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP-HAM) patients. We conducted a prospective cohort study to compare spirometry and high-resolution computed tomography (HRCT) findings among 28 HTLV-1-carrier patients over the course of 6 years (2014–2019) (male/female: 7/21; mean age: 54.7 ± 9.5, range: 41–68 years). Chest HRCT exams revealed the development and evolution of lung lesions related to TSP-HAM: including centrilobular nodules, parenchymal bands, lung cysts, bronchiectasis, ground-glass opacity, mosaic attenuation, and pleural thickening. Spirometry exams showed maintenance of respiratory function, with few alterations in parameters suggestive of obstructive and restrictive disorders primarily in individuals with lung lesions and TSP-HAM. The findings of the present study indicate that pulmonary disease related to HTLV-1 is a progressive disease, with development of new lung lesions, mainly in individuals with TSP-HAM. To improve clinical management of these individuals, we recommend that individuals diagnosed with PET-MAH undergo pulmonary evaluation.

Multiple meningiomas in different neuroaxial locations: report of a rare case

We report a rare case of multiple meningiomas in a 74 year old female who was brought to the hospital with spastic paraparesis and MRI of spine and brain revealed multiple enhancing meningiomas in brain and spines. The spinal intradural extramedullary (IDEM) meningioma at C7-D1 level was excised which had caused paraparesis and postoperatively patient became symptom free. We will discuss about the incidence, symptomatology, investigations and management of multiple meningiomas in different neuroaxial compartments at the same period of time and will review the literature.

Immunoprofiling of fresh HAM/TSP blood samples show altered innate cell responsiveness

The Human T-cell Leukemia Virus-1 (HTLV-1)-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a devastating neurodegenerative disease with no effective treatment, which affects an increasing number of people in Brazil. Immune cell from the adaptive compartment are involved in disease manifestation but whether innate cell functions participate in disease occurrence has not been evaluated. In this study, we analyzed innate cell responses at steady state and after blood cell stimulation using an agonist of the toll-like receptor (TLR)7/8-signaling pathway in blood samples from HTLV-1-infected volunteers, including asymptomatic carriers and HAM/TSP patients. We observed a lower response of IFNα+ DCs and monocytes in HAM/TSP compared to asymptomatic carriers, as a potential consequence of corticosteroid treatments. In contrast, a higher frequency of monocytes producing MIP-1α and pDC producing IL-12 was detected in HAM/TSP blood samples, together with higher IFNγ responsiveness of NK cells, suggesting an increase sensitivity to inflammatory response in HAM/TSP patients compared to asymptomatic carriers. This sustained inflammatory responsiveness could be linked or be at the origin of the neuroinflammatory status in HAM/TSP patients. Therefore, the mechanism underlying this dysregulations could shed light onto the origins of HAM/TSP disease.

Case Report: Relevance of an Accurate Diagnosis and Monitoring of Infective Dermatitis Associated With Human T-Lymphotropic Virus Type 1 in Childhood

Human T-lymphotropic virus type 1 (HTLV-1) is a neglected retrovirus distributed worldwide and the ethiological agent of several pathologies, such as adult T-cell leukemia/lymphoma (ATLL), a chronic myelopathy known as HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and infective dermatitis associated with HTLV-1 (IDH). HTLV-1 presents tropism for CD4+ T cells and induces deregulation of the cytokine profile. IDH is a severe, chronic superinfected eczema generally associated with Staphylococcus aureus and/or Streptococcus beta haemolyticus infection that responds partially to antibiotic therapy but prompt recurrence develops upon treatment withdrawal. IDH could be a risk factor for progression toward both HAM/TSP and ATLL and, similarly to other diseases associated with HTLV-1, it is sub-diagnosed particularly in non-endemic areas. Here, we present a case of IDH in a young boy living in Buenos Aires with symptoms since 2010, at the age of 5. HTLV-1 infection was suspected and confirmed in 2016. The patient exhibited chronic dermatosis with exudative eruption involving mainly the scalp, retroauricular regions, neck and abdomen. Clinical evaluations, routine laboratory tests, full blood count, and HTLV-1 diagnosis for this case are included.