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Ocular manifestations in patients with HTLV-I associated infection--a clinical study of 93 cases
H Merle1, D Smadja, P Le Hoang
1Service d'Ophtalmologie, Centre Hospitalier Universitaire de Fort-de-France, Martinique, French West Indies.
Abstract:
The purpose of this study was to confirm that ophthalmological features seen in patients in Martinique, French West Indies, could be linked to infection by HTLV-I. The authors studied 93 HTLV-I infected patients divided into 70 patients with HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) and 23 asymptomatic HTLV-I carriers. They did a complete ophthalmological examination with an assessment of lacrymal secretion by means of three tests: Shirmer 1, break-up time and rose Bengal. Some patients had a biopsy of secondary salivary glands. When possible, detection of HTLV-I antibodies was carried out in the aqueous humor. In 45 of the 93 patients (48.4%) the presence of dry keratoconjunctivitis was recorded. In 22 of these 45 cases, a biopsy of the secondary salivary glands showed the presence of lymphoplasmocytoid infiltrations comparable to the glandular changes that occur with Gougerot-Sjögren syndrome. Among the 93 patients, 15 cases of uveitis were noted (16.1%) with 13 cases of anterior uveitis and 11 cases of vitritis. The inflammation was bilateral in 9 cases (9/15 = 60%). Two cases of cotton wool spots, 3 cases of abnormalities in the distribution of the retinal pigment and 7 cases of corneal lesions were also noted. Higher levels of anti-HTLV-I antibodies were detected in the aqueous humor of 3 patients with uveitis. The coexistence of dry eye (keratoconjunctivitis), uveitis and retinal microangiopathy in patients who are suffering from HAM/TSP could suggest the involvement of an autoimmune or immunological mechanism in the physiopathology of the illness.
Insights
Ophthalmological issues like dry eye and uveitis are common in patients infected with Human T-lymphotropic virus type 1 (HTLV-I), particularly those with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). These findings suggest an autoimmune link in HTLV-I disease progression.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Human T-lymphotropic virus type 1 (HTLV-I) infection is endemic in Martinique.
- HTLV-I is associated with neurological conditions like HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP).
- Ophthalmological manifestations in HTLV-I patients require further investigation.
Purpose of the Study:
- To investigate the link between HTLV-I infection and specific ophthalmological findings in patients from Martinique.
- To assess the prevalence of dry keratoconjunctivitis and uveitis in HTLV-I infected individuals.
- To explore potential autoimmune mechanisms in HTLV-I-related eye conditions.
Main Methods:
- Conducted comprehensive ophthalmological examinations on 93 HTLV-I infected patients (70 with HAM/TSP, 23 asymptomatic).
- Assessed lacrimal secretion using Schirmer 1, tear break-up time, and rose Bengal tests.
- Performed secondary salivary gland biopsies and, where possible, detected HTLV-I antibodies in aqueous humor.
Main Results:
- Dry keratoconjunctivitis was observed in 48.4% of patients.
- Salivary gland biopsies revealed lymphoplasmacytic infiltrations in 22 cases, similar to Gougerot-Sjögren syndrome.
- Uveitis occurred in 16.1% of patients, with anterior uveitis and vitritis being common; retinal microangiopathy was also noted.
- Elevated anti-HTLV-I antibodies in aqueous humor were found in 3 uveitis patients.
Conclusions:
- A significant proportion of HTLV-I infected patients exhibit dry eye and uveitis.
- The presence of these conditions, alongside microangiopathy in HAM/TSP patients, suggests an autoimmune or immunological basis.
- Further research into the immunopathology of HTLV-I is warranted to understand these ophthalmological complications.