HTLV-1的性传播引发短潜伏期低载体病毒量伴发葡萄膜炎的病例报告
Sexual transmission of HTLV-1 resulting in uveitis with short-term latency and low proviral load
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影响因子:4.6
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
DOI:
10.1002/jmv.70000
摘要
人T细胞淋巴瘤病毒-1型（HTLV-1）传统上与成人T细胞白血病/淋巴瘤、HTLV-1相关脊髓病及HTLV-1葡萄膜炎等严重疾病有关，垂直传播（尤其是母乳喂养）被视为主要途径。尽管日本已通过产前筛查减少垂直传播，但水平传播仍促使HTLV-1在大都市地区的流行率上升。本病例报告一名18岁女性，最年轻的通过性接触水平传播引发HTLV-1葡萄膜炎的病例。患者表现为右眼视模糊，经全面眼科检查发现玻璃体混浊和视网膜血管炎。血清学检测确认HTLV-1感染，实时PCR测得病毒载量为每100个外周血单核细胞中2.66个拷贝。鉴别诊断确认为HTLV-1葡萄膜炎。进一步的家庭和伴侣检测证实为性接触传播。6年随访期间，患者多次复发HTLV-1葡萄膜炎并发展为HTLV-1相关角膜病。此病例强调了病毒载量较低、潜伏期短时疾病快速进展的可能性，提示需更新针对性活跃年轻人群的公共卫生策略。
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.