HTLV-1的性传播导致葡萄膜炎，短期潜伏期和前病毒负荷较低
Sexual transmission of HTLV-1 resulting in uveitis with short-term latency and low proviral load
影响因子:4.60000
分区:医学3区 / 病毒学3区
发表日期:2024 Oct
作者:
Koju Kamoi, Kaoru Uchimaru, Yasuhito Nannya, Arinobu Tojo, Toshiki Watanabe, Kyoko Ohno-Matsui
摘要
人类T细胞淋巴病毒1型（HTLV-1）传统上与严重的疾病有关，例如成人T细胞白血病/淋巴瘤，HTLV-1相关的脊髓病，HTLV-1葡萄膜炎，以及垂直传播的HTLV-1葡萄膜炎，尤其是母亲彻底的母乳喂养。尽管努力通过日本的产前筛查减少垂直传播，但水平传播却导致了大都市地区HTLV-1的患病率上升。该病例报告了一名18岁妇女通过性接触而导致的HTLV-1葡萄膜炎的最年轻的HTLV-1葡萄膜炎实例。该患者的右眼表现出视力模糊，全面的眼科检查确定了玻璃体不透明性和视网膜血管炎。血清学测试证实了HTLV-1感染，前毒毒负荷为每100份外周血单核细胞的2.66份，通过实时PCR测量。鉴别诊断证实了HTLV-1葡萄膜炎。进一步的家庭和伴侣调查证实了水平传播，最有可能通过性接触。在6年的随访中，该患者经历了HTLV-1葡萄膜炎的多次复发，并发展了HTLV-1相关的角化病。这种情况强调了可能以相对较低的前病毒负荷和短期延迟的快速疾病进展的潜力，强调需要更新性活跃年轻人的公共卫生策略。
Abstract
Human T-cell Lymphotropic Virus Type 1 (HTLV-1) is traditionally linked to severe conditions such as adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy, and HTLV-1 uveitis, with vertical transmission, particularly mother to child thorough breastfeeding, considered the primary route. Despite efforts to reduce vertical transmission through antenatal screening in Japan, horizontal transmission has contributed to the rising prevalence of HTLV-1 in metropolitan areas. This case reports the youngest documented instance of HTLV-1 uveitis resulting from horizontal transmission through sexual contact in an 18-year-old woman. The patient presented with blurred vision in her right eye, and a comprehensive ophthalmologic examination identified vitreous opacity and retinal vasculitis. Serological tests confirmed HTLV-1 infection, with a proviral load of 2.66 copies per 100 peripheral blood mononuclear cells, measured by real-time PCR. A differential diagnosis confirmed HTLV-1 uveitis. Further family and partner investigations confirmed horizontal transmission, most likely through sexual contact. Over 6 years of follow-up, the patient experienced multiple recurrences of HTLV-1 uveitis and developed HTLV-1-associated keratopathy. This case highlights the potential for rapid disease progression with relatively low proviral loads and short latency, emphasizing the need for updated public health strategies for sexually active young populations.