De Mendoza Carmen, Pirón Maria, Gonzalez Rocío, Jiménez Ana, Caballero Estrella, Roc Lourdes, Benito Rafael, Ramos Jose Manuel, Soriano Vicente
Puerta de Hierro Research Institute and University Hospital, Majadahonda, Madrid.
Blood and Tissue Bank, Barcelona.
Open Forum Infect Dis. 2019 Jan 16;6(2):ofz036. doi: 10.1093/ofid/ofz036. eCollection 2019 Feb.
Although only 8%-10% of persons infected with human T-cell leukemia virus type 1 (HTLV-1) may develop virus-associated diseases lifelong, misdiagnosis of asymptomatic infected carriers frequently leads to late diagnoses.
A nationwide HTLV-1 register was created in Spain in 1989. A total of 351 infected persons had been reported by the end of 2017. We examined all new HTLV-1 diagnoses during the last decade and compared their clinical presentation.
A total of 247 individuals with HTLV-1 infection had been reported in Spain since year 2008. The incidence has remained stable with 20-25 new diagnoses yearly. Women represented 62%. Only 12% were native Spaniards, most of whom were foreigners from Latin America (72.5%). Up to 57 (23%) individuals presented clinically with HTLV-1-associated conditions, including subacute myelopathy (n = 24; 42.1%), T-cell lymphoma (n = 19; 33.3%), or infestation (n = 8; 14%). Human T-cell leukemia virus type 1 diagnosis had been made either at blood banks (n = 109; 44%) or at clinics (n = 138; 56%). It is interesting to note that Spaniards and especially Africans were overrepresented among patients presenting with HTLV-1-associated illnesses, suggesting that misdiagnosis and late presentation are more frequent in these populations compared to Latin Americans.
Given that 23% of new HTLV-1 diagnoses in Spain are symptomatic, underdiagnosis must be common. Although screening in blood banks mostly identifies asymptomatic Latin American carriers, a disproportionately high number of Spaniards and Africans are unveiled too late, that is, they already suffer from classic HTLV-1 illnesses.
虽然感染1型人类T细胞白血病病毒（HTLV-1）的人中只有8%-10%可能终身罹患与病毒相关的疾病，但对无症状感染携带者的误诊常常导致诊断延迟。
1989年在西班牙建立了一个全国性的HTLV-1登记处。到2017年底，共报告了351名感染者。我们检查了过去十年中所有新的HTLV-1诊断病例，并比较了它们的临床表现。
自2008年以来，西班牙共报告了247例HTLV-1感染病例。发病率保持稳定，每年有20-25例新诊断病例。女性占62%。只有12%是西班牙本地人，其中大多数是来自拉丁美洲的外国人（72.5%）。多达57名（23%）个体临床上表现为与HTLV-1相关的病症，包括亚急性脊髓病（n = 24；42.1%）、T细胞淋巴瘤（n = 19；33.3%）或寄生虫感染（n = 8；14%）。HTLV-1诊断是在血库（n = 109；44%）或诊所（n = 138；56%）进行的。值得注意的是，在出现与HTLV-1相关疾病的患者中，西班牙人尤其是非洲人的比例过高，这表明与拉丁美洲人相比，这些人群中的误诊和延迟就诊更为常见。
鉴于西班牙新诊断的HTLV-1病例中有23%有症状，漏诊肯定很常见。虽然血库筛查大多发现无症状的拉丁美洲携带者，但西班牙人和非洲人的数量不成比例地过高，且发现得太晚，也就是说，他们已经患有典型的HTLV-1疾病。
