移民人群中 HTLV 的流行率和特征：来自西班牙+Redivi 合作网络的研究结果。

National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, CIBER de Enfermedades Infecciosas, Madrid, Spain.

Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain.

J Travel Med. 2022 Nov 4;29(7). doi: 10.1093/jtm/taac019.

INTRODUCTION

The objective of this study was to describe the main characteristics of migrants diagnosed with human T-lymphotropic virus (HTLV) infection within the +Redivi Spanish network.

METHODS

Patients with a diagnosis of HTLV type 1 or 2 in +Redivi from October 2009 to December 2020 were included. Diagnosis was based on positive HTLV serology (enzyme-linked immunosorbent assay (ELISA)/chemiluminescent immunoassay (CLIA)) with line immunoassay (LIA)/Western blot with/without polymerase chain reaction (PCR).

RESULTS

A total of 107/17 007 cases (0.6%) had a final diagnosis of HTLV infection: 83 (77.67%) HTLV-1 infections, 6 (5.6%) HTLV-2 infections and 18 (16.8%) non-specified. The majority (76, 71%) were female, median age was 42 years and median time from arrival to Spain until consultation was 10 years. The group included 100 (93.5%) immigrants and 7 (6.6%) visiting friends and relatives (VFR)-immigrants. Most patients were from South America (71, 66.4%), followed by Sub-Saharan Africa (15, 14%) and Central America-Caribbean (13, 12.1%). Around 90% of patients were asymptomatic at presentation and diagnosed as part of screening programs. Median duration of follow-up was 5 years (IQR 2-7). Regarding HTLV-associated conditions, 90 patients (84.2%) had none, 7 (6.5%) had tropical spastic paraparesis , 5 (4.7%) had other associated conditions (dermatitis, uveitis, pulmonary disease), 3 (2.8%) had other neurological symptoms and 2 (1.9%) had adult T-cell leukaemia/lymphoma. No patients with HTLV-2 had HTLV-associated conditions. Four patients (3.7%) died. Concomitant diagnoses were found in 41 (38.3%) patients, including strongyloidiasis in 15 (14%) and HIV co-infection in 4 (3.7%). In 70% of patients, screening of potential contacts was not performed/recorded.

CONCLUSIONS

HTLV infections (the majority due to HTLV-1) were mainly diagnosed in asymptomatic migrants from Latin America (generally long-settled immigrants and the majority female with the consequent implications for screening/prevention). A high rate of association with strongyloidiasis was found. In the majority, screening of potential contacts was not performed, representing a missed opportunity for decreasing the under diagnosis of this infection.

简介

本研究的目的是描述在+Redivi 西班牙网络中诊断为人类 T 淋巴细胞病毒 (HTLV) 感染的移民的主要特征。

方法

纳入 2009 年 10 月至 2020 年 12 月期间在+Redivi 中诊断为 HTLV 1 或 2 型的患者。诊断基于酶联免疫吸附试验 (ELISA)/化学发光免疫分析 (CLIA) 阳性的 HTLV 血清学（线免疫分析 (LIA)/Western blot 有/无聚合酶链反应 (PCR)）。

结果

共有 107/17007 例（0.6%）最终诊断为 HTLV 感染：83 例（77.67%）HTLV-1 感染，6 例（5.6%）HTLV-2 感染和 18 例（16.8%）未指定。大多数（76 例，71%）为女性，中位年龄为 42 岁，从到达西班牙到就诊的中位时间为 10 年。该组包括 100 名（93.5%）移民和 7 名（6.6%）探亲移民。大多数患者来自南美洲（71 例，66.4%），其次是撒哈拉以南非洲（15 例，14%）和中美洲-加勒比地区（13 例，12.1%）。大约 90%的患者在出现症状时无症状，并作为筛查计划的一部分进行诊断。中位随访时间为 5 年（IQR 2-7）。关于 HTLV 相关疾病，90 名患者（84.2%）无任何疾病，7 名（6.5%）患有热带痉挛性截瘫，5 名（4.7%）患有其他相关疾病（皮炎、葡萄膜炎、肺部疾病），3 名（2.8%）有其他神经系统症状，2 名（1.9%）患有成人 T 细胞白血病/淋巴瘤。没有 HTLV-2 感染患者有 HTLV 相关疾病。4 名患者（3.7%）死亡。41 名（38.3%）患者同时诊断出其他疾病，包括 15 名（14%）患有 Strongyloides 感染和 4 名（3.7%）患有 HIV 合并感染。在 70%的患者中，未对潜在接触者进行筛查/记录。