rev bras hematol hemoter. 2015;37(2):130–131
w w w . r b h h . o r g
Revista
Brasileira
de
Hematologia
e
Hemoterapia
Brazilian
Journal
of
Hematology
and
Hemotherapy
Case
Report
Endemic
transmission
of
HTLV-2
in
blood
donors
from
São
Luís
do
Maranhão,
northeastern
Brazil:
report
of
two
asymptomatic
individuals
Grac¸a
Maria
de
Castro
Viana
∗,
Marcos
Antonio
Custódio
Neto
da
Silva,
Victor
Lima
Souza,
Natália
Barbosa
da
Silva
Lopes,
Maria
do
Desterro
Soares
Brandão
Nascimento
UniversidadeFederaldoMaranhão(UFMA),SãoLuís,MA,Brazil
a
r
t
i
c
l
e
i
n
f
o
Articlehistory:
Received16May2014 Accepted1July2014
Availableonline21November2014
Introduction
HumanT-cell lymphotropicvirus 1and 2(HTLV-1, HTLV-2) belongtotheRetroviridaefamily,genusDeltaretrovirus1,2 and
have similar biological properties, with tropism of T lym-phocytes.Theyareassociatedwithrarelymphoproliferative diseases.3,4
BrazilhasahighseroprevalenceofHTLV-1/2amongblood donors.Themeanprevalencerangesfrom0.4/1000in Flori-anópolisto10.0/1000inSãoLuísdoMaranhão.5
ThefirstcaseofHTLV-2wasdescribedin1982inapatient with hairy cell leukemia.6 The virus is acquired through
unprotectedsexualintercourse,byverticaltransmissionand, inEurope and North America, infection isassociated with intravenousdrugusers.HTLV-2isendemicinsomeIndian vil-lagesandurbanpopulationsinnorthernBrazil,7inthestate
ofSãoPauloandinthecentralwesternregionofthecountry.8
HTLV-2 can be classified into four major subtypes: HTLV-2a, HTLV-2b, HTLV-2c and HTLV-2d by molecular
∗ Correspondingauthorat:UniversidadeFederaldoMaranhão(UFMA),Prac¸aMadreDeus1,MadreDeus,SãoLuís,MA,Brazil.
E-mailaddress:gracaviana@globo.com(G.M.d.C.Viana).
characterization.9 AlthoughHTLV-2does notshowany
def-inite association with lymphoproliferative diseases, some studies havesuggestedthatitmay alsobeassociatedwith HTLV-I-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) and other neurological syndromes, as well as increasedincidenceofpneumonia,bronchitisand inflamma-toryconditionsandarthritis.10
ThesecasereportsshowtheoccurrenceofHTLV-2inblood donorsofthestateofMaranhãoforthefirsttime,thus indi-catingtheneedforworkonthisissueintheregiontodiscover therealprevalenceofthevirus.
Case
report
Twopatientswerereferredtotheclinicspecializingin HTLV-1/2 at the Supervisão de Hematologia e Hemoterapia do Maranhão(HEMOMA).Bothwomenweremarriedhousewives livinginSãoLuísdoMaranhãowithonlyelementary school-ing.Onewas54yearsoldandtheotherwas61yearsold.They
http://dx.doi.org/10.1016/j.bjhh.2014.11.003
revbrashematolhemoter.2015;37(2):130–131
131
donatedbloodforfamilymembersbutthescreening labora-torytest(ELISA)waspositive forHTLV-1/2.Thisresultwas confirmedforHTLV-2byWesternblot.Thepatientsdenied havingafamilyhistoryofHTLV,bloodtransfusionsor infec-tiousdermatitisduringchildhood.Theirpartnersrefusedto performbloodtests.Thepatients’physicalexaminationsand laboratory analyses, including complete blood count, urea, creatinine,fastingglucose,uricacid,lipidprofile,TSH,T3and freeT4,wereunremarkable.
Discussion
HTLV-1/2infectionisendemicinBrazil11withaprevalenceof
5%ofthepopulation.ThereisahighincidenceinMaranhão, wheretenoutofevery1000blooddonorsareseropositive.12
However, these figures do not show the real situation in the population of Maranhão as they are for blood donors andnotthegeneralpublic.AstudyconductedinSãoPaulo foundarateof20.7%forHTLV-2a/b13andarateof0.24%for
HTLV-2a/cwasfoundinapopulationofthecentral-western region of Brazil in patients co-infected with pulmonary tuberculosis.8
InregionswhereHTLV-2infection isendemic,the high-estprevalenceisassociatedwithincreasedageanddecreased socioeconomicstatus,especiallyinwomen,14which
corrobo-ratesourfindings.
Thepathogenic inferiorityofHTLV-2comparedto HTLV-115isknownandsoitisnotclearlyassociatedwithdiseases,
althoughtherearereportsofanassociationofHTLV-2with neurologicaldiseasesandincreasedincidenceofrespiratory infections16;thisexplainstheabsenceofsymptomsreported
inthesepatients.
Conclusion
These case reports will contribute to the planning and implementationofcontrolmeasuresbytheepidemiological surveillanceagencyofMaranhão.Thus,despiteofthesmall samplesizeinblooddonors,thisseropositivityindicatesthe needoffurtherstudiesinthewholepopulationofthestateof Maranhão.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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