Implications of human T‑lymphotropic virus in pregnancy: A case report and a review of the diagnostic criteria and management proposal

Bohiltea,Roxana Elena; Turcan,Natalia; Berceanu,Costin; Munteanu,Octavian; Georgescu,Tiberiu Augustin; Ducu,Ionita; Neacsu,Adrian; Furtunescu,Florentina

doi:10.3892/etm.2020.9514

Implications of human T‑lymphotropic virus in pregnancy: A case report and a review of the diagnostic criteria and management proposal

Authors:
- Roxana Elena Bohiltea
- Natalia Turcan
- Costin Berceanu
- Octavian Munteanu
- Tiberiu Augustin Georgescu
- Ionita Ducu
- Adrian Neacsu
- Florentina Furtunescu
View Affiliations

Affiliations: Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania, Department of Obstetrics Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania, Department of Pathology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050463 Bucharest, Romania, Department of Public Health and Management, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050463 Bucharest, Romania
Published online on: November 26, 2020 https://doi.org/10.3892/etm.2020.9514
Article Number: 82

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Human T‑lymphotropic virus (HTLV) is considered to be the most highly oncogenic existing virus, being the cause of several fatal diseases such as adult T cell leukemia‑lymphoma (ATL) and HTLV‑I‑associated myelopathy (HAM). The main transmission methods are unprotected sexual intercourse, vertical transmission and breastfeeding and direct exposure to infected blood or tissue. The identification of infected mothers prior to delivery is a highly important step in preventing mother to child transmission. Universal antenatal screening for HTLV is not recommended in Romania, although there are sufficient data demonstrating the risk of vertical transmission. We present the case of an HTLV‑1-infected pregnant woman, with an aim to highlight: i) points of strategy for the management of HTLV during pregnancy; ii) the particularities of the course of pregnancy; and iii) the aspects that show the importance of knowing the status regarding the HTLV infection antepartum. The case was particular due to the ascendant proviral load during the pregnancy period, which led to the initiation of antiretroviral therapy and the particular pregnancy outcome with preterm rupture of membranes and fetal growth restriction. According to current recommendations, pregnant women infected with HTLV‑1 should be advised to refrain from donating blood, body organs, or other tissues. There is no evidence of the number of individuals infected with this virus in Romania at present, and the diagnosis can only occur by chance. A specific treatment or immunization for HTLV infection does not currently exist, thus preventive methods are the only tool to reduce the prevalence and mortality of this infection.

View Figures

View References

1	de Thé G and Bomford R: An HTLV-I vaccine: Why, how, for whom? AIDS Res Hum Retroviruses. 9:381–386. 1993.PubMed/NCBI View Article : Google Scholar
2	Katsuya H, Ishitsuka K, Utsunomiya A, Hanada S, Eto T, Moriuchi Y, Saburi Y, Miyahara M, Sueoka E, Uike N, et al: Treatment and survival among 1594 patients with ATL. Blood. 126:2570–2577. 2015.PubMed/NCBI View Article : Google Scholar
3	Hinuma Y, Nagata K, Hanaoka M, Nakai M, Matsumoto T, Kinoshita KI, Shirakawa S and Miyoshi I: Adult T-cell leukemia: Antigen in an ATL cell line and detection of antibodies to the antigen in human sera. Proc Natl Acad Sci USA. 78:6476–6480. 1981.PubMed/NCBI View Article : Google Scholar
4	Hieshima K, Nagakubo D, Nakayama T, Shirakawa AK, Jin Z and Yoshie O: Tax-inducible production of CC chemokine ligand 22 by human T cell leukemia virus type 1 (HTLV-1)-infected T cells promotes preferential transmission of HTLV-1 to CCR4-expressing CD4⁺ T cells. J Immunol. 180:931–939. 2008.PubMed/NCBI View Article : Google Scholar
5	Fuchi N, Miura K, Tsukiyama T, Sasaki D, Ishihara K, TsurudaK Hasegawa H, Miura S, Yanagihara K and Masuzaki H: Natural course of human T-Cell leukemia virus type 1 proviral DNA levels in carriers during pregnancy. J Infect Dis. 217:1383–1389. 2018.PubMed/NCBI View Article : Google Scholar
6	Murphy EL, Hanchard B, Figueroa JP, Gibbs WN, Lofters WS, Campbell M, Goedert JJ and Blattner WA: Modelling the risk of adult T-cell leukemia/lymphoma in persons infecte.d with human T-lymphotropic virus type I. Int J Cancer. 43:250–253. 1989.PubMed/NCBI View Article : Google Scholar
7	Kinoshita K, Hino S, Amagaski T, Ikeda S, Yamada Y, Suzuyama S, Momita S, Toriya K, Kamihira S and Ichimaru M: Demonstration of adult T-cell leukemia virus antigen in milk from three sero-positive mothers. Gan. 75:103–105. 1984.PubMed/NCBI
8	Bohîlţea RE, Cîrstoiu MM, Ionescu CA, Niculescu-Mizil E, Vlădăreanu AM, Voican I, Dimitriu M and Turcan N: Primary myelofibrosis and pregnancy outcomes after low molecular-weight heparin administration: A case report and literature review. Medicine (Baltimore). 96(e8735)2017.PubMed/NCBI View Article : Google Scholar
9	Nakagawa M, Izumo S, Ijichi S, Kubota H, Arimura K, Kawabata M and Osame M: HTLV-I-associated myelopathy: Analysis of 213 patients based on clinical features and laboratory findings. J Neurovirol. 1:50–61. 1995.PubMed/NCBI View Article : Google Scholar
10	WHO. Virus diseases: Human T lymphotropic virus type I, HTLV-I. Wkly Epidemiol Rec 64: 382, 1989.
11	Takenouchi N, Yamano Y, Usuku K, Osame M and Izumo S: Usefulness of proviral load measurement for monitoring of disease activity in individual patients with human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis. J Neurovirol. 9:29–35. 2003.PubMed/NCBI View Article : Google Scholar
12	Miley WJ, Suryanarayana K, Manns A, Kubota R, Jacobson S, Lifson JD and Waters D: Real-time polymerase chain reaction assay for cell-associated HTLV type I DNA viral load. AIDS Res Hum Retroviruses. 16:665–675. 2000.PubMed/NCBI View Article : Google Scholar
13	Yonemoto N, Suzuki S, Sekizawa A, Hoshi S, Sagara Y and Itabashi K: Implementation of nationwide screening of pregnant women for HTLV-1 infection in Japan: Analysis of a repeated cross-sectional study. BMC Public Health. 20(1150)2020.PubMed/NCBI View Article : Google Scholar
14	Martin F, Tagaya Y and Gallo R: Time to eradicate HTLV-1: An open letter to WHO. Lancet. 391:1893–1894. 2018.PubMed/NCBI View Article : Google Scholar
15	Ribeiro MA, Proietti FA, Martins ML, Januário JN, Ladeira RV, Oliveira Mde F and Carneiro-Proietti AB: Geographic distribution of human T-lymphotropic virus types 1 and 2 among mothers of newborns tested during neonatal screening, Minas Gerais, Brazil. Rev Panam Salud Publica. 27:330–337. 2010.PubMed/NCBI View Article : Google Scholar
16	Bohîlțea RE, Zugravu CA, Neacsu A, Navolan D, Berceanu C, Nemescu D, Bodean O, Turcan N, Baros Al and Cîrstoiu MM: The prevalence of vitamin D deficiency and its obstetrical effects. A prospective study on Romanian patients. Rev Chim. 70:1228–1233. 2019.
17	Lima LH and Viana MC: Prevalence and risk factors for HIV, syphilis, hepatitis B, hepatitis C, and HTLV-I/II infection in low-income postpartum and pregnant women in Greater Metropolitan Vitória, Espírito Santo State, Brazil. Cad Saude Publica. 25:668–676. 2009.PubMed/NCBI View Article : Google Scholar
18	Bohiltea RE, Zugravu CA, Nemescu D, Turcan N, Paulet FP, Gherghiceanu F, Ducu I and Cirstoiu MM: Impact of obesity on the prognosis of hypertensive disorders in pregnancy. Exp Ther Med. 20:2423–2428. 2020.PubMed/NCBI View Article : Google Scholar
19	Alarcón JO, Friedman HB, Montano SM, Zunt JR, Holmes KK and Quinnan GV Jr: High endemicity of human T-cell lymphotropic virus type 1 among pregnant women in Peru. J Acquir Immune Defic. Syndr. 42:604–609. 2006.PubMed/NCBI View Article : Google Scholar
20	Macchi B, Balestrieri E and Mastino A: Effects of nucleoside-based antiretroviral chemotherapy on human T cell leukaemia/lymphotropic virus type 1 (HTLV-1) infection in vitro. J Antimicrob Chemother. 51:1327–1330. 2003.PubMed/NCBI View Article : Google Scholar
21	Balestrieri E, Forte G, Matteucci C, Mastino A and Macchi B: Effect of lamivudine on transmission of human T-cell lymphotropic virus type 1 to adult peripheral blood mononuclear cells in vitro. Antimicrob Agents Chemother. 46:3080–3083. 2002.PubMed/NCBI View Article : Google Scholar
22	Taylor GP, Goon P, Furukawa Y, Green H, Barfield A, Mosley A, Nose H, Babiker A, Rudge P, Usuku K, et al: Zidovudine plus lamivudine in human T-lymphotropic virus type-I-associated myelopathy: A randomised trial. Retrovirology. 3(63)2006.PubMed/NCBI View Article : Google Scholar
23	Centers for Disease Control (CDC): Human T-lymphotropic virus type I screening in volunteer blood donors-United States, 1989. MMWR Morb Mortal Wkly Rep 39: 915, 921-924, 1990.
24	Namen-Lopes MS, Martins ML, Drummond PC and Lobato RR: Interdisciplinary HTLV research group (GIPH) and Carneiro-Proietti AB: Lookback study of HTLV-1 and 2 seropositive donors and their recipients in Belo Horizonte, Brazil. Transfus Med. 19:180–188. 2009.PubMed/NCBI View Article : Google Scholar
25	Leal MD, Esteves-Pereira AP, Nakamura-Pereira M, Torres JA, Theme-Filha M, Domingues RM, Dias MA, Moreira ME and Gama SG: Prevalence and risk factors related to preterm birth in Brazil. Reprod Health. 13 (Suppl 3)(S127)2016.PubMed/NCBI View Article : Google Scholar
26	Bohîlțea R, Turcan N, Ionescu C, Toader O, Nastasia S, Neculcea D, Movileanu I, Munteanu O and Cîrstoiu M: The incidence of prematurity and associated short-term complications in a multidisciplinary emergency hospital from Romania. 5th Romanian Congress of the Romanian Society of Ultrasound in Obstetr Gynecol. 105–112. 2017.
27	Turcan N, Bohîlțea R, Neacsu A, Baros Al and Cîrstoiu MM: The role of anticoagulant therapy in the prevention of preeclampsia Pharmacokinetic and pharmacodinamic mechanisms. Rev Chim. 70:1424–1428. 2019.
28	Ville Y, Delaporte E, Peeters M, Leruez M, Glowaczower E and Fernandez H: Human T-cell lymphotropic virus type I infection and pregnancy: A case-control study and 12-month follow-up of 135 women and their infants. Am J Obstet Gynecol. 165:1438–1443. 1991.PubMed/NCBI View Article : Google Scholar
29	Bohîlțea R, Furtunescu F, Turcan N, Navolan D, Ducu I and Cîrstoiu M: Prematurity and intrauterine growth restriction: Comparative analysis of incidence and short term complication. Proceedings of SOGR 2018. The 17th National Congress of the Romanian Soc Obstet Gynecol. 2018:708–712. 2019.
30	Bittencourt Al, Dourado I, Filho PB, Santos M, Valadão E, Alcantara LC and Galvão-Castro B: Human T-cell lymphotropic virus type I infection among pregnant women in northeastern Brazil. J Acquir Immune Defic Syndr. 26:490–494. 2001.PubMed/NCBI View Article : Google Scholar
31	Carneiro-Proietti AB, Amaranto-Damasio MS, Leal-Horiguchi CF, Bastos RH, Seabra-Freitas G, Borowiak DR, Ribeiro MA, Proietti FA, Ferreira AS and Martins M: Mother-to-child transmission of human T-cell lymphotropic viruses-1/2: What we know, and what are the gaps in understanding and preventing this route of infection. J Pediatr Infect Dis Soc. 3 (Suppl 1):S24–S29. 2014.PubMed/NCBI View Article : Google Scholar
32	Turcan N, Bohiltea RE, Ionita-Radu F, Furtunescu F, Navolan D, Berceanu C, Nemescu D and Cirstoiu MM: Unfavorable influence of prematurity on the neonatal prognostic of small for gestational age fetuses. Exp Ther Med. 20:2415–2422. 2020.PubMed/NCBI View Article : Google Scholar
33	Toyama J, Kawahara H, Inagaki M, Ohno K, Takeshita K and Egi T: Clinical and neuroradiologic findings of congenital hydrocephalus in infants born to mother with HTLV-I-associated myelopathy. Neurology. 42:1406–1408. 1992.PubMed/NCBI View Article : Google Scholar
34	Bohîlţea RE, Tufan CF, Cîrstoiu MM, Dumitru AV, Georgescu TA, Sajin M, Bodean OM, Munteanu O, Brătilă E, Ofiţeru AM and Berceanu C: Body stalk anomaly in a monochorionic-diamniotic twin pregnancy-case report and review of the literature. Rom J Morphol Embryol. 58:1453–1460. 2017.PubMed/NCBI
35	Munteanu O, Cîrstoiu MM, Filipoiu FM, BohîlŢea RE, Bulescu IA and Berceanu C: Morphological and ultrasonographic study of fetuses with cervical hygroma. A case series. Rom J Morphol Embriol. 57:1421–1427. 2016.PubMed/NCBI
36	Kendall EA, González E, Espinoza I, Tipismana M, Verdonck K, Clark D, Vermund SH and Gotuzzo E: Early neurologic abnormalities associated with human T-cell lymphotropic virus type 1 infection in a cohort of Peruvian children. J Pediatr. 155:700–706. 2009.PubMed/NCBI View Article : Google Scholar
37	Fujino T, Fujiyoshi T, Yashiki S, Sonoda S, Otsuka H and Nagata Y: HTLV-I ttransmission from mother to fetus via placenta. Lancet. 340(1157)1992.PubMed/NCBI View Article : Google Scholar
38	Bohîlțea RE, Turcan N, Ionescu CA, Mehedințu C, Nastasia Ș Toader O, Munteanu O and Cîrstoiu MM: Ultrasound diagnosis of abnormal adherent placenta-Literature Review. Filodiritto Editore-Proceedings. 5th Romanian Congress of the Romanian Soc Ultrasound Obstetr Gynecol. 113–119. 2017.
39	Paiva AM, Assone T, Haziot ME, Smid J, Fonseca LA, Luiz ODC, de Oliveira ACP and Casseb J: Risk factors associated with HTLV-1 vertical transmission in Brazil: Longer breastfeeding, higher maternal proviral load and previous HTLV-1-infected offspring. Sci Rep. 8(7742)2018.PubMed/NCBI View Article : Google Scholar
40	Nastas A, Stanculescu R, Mehedințu C, Berceanu C, Comandasu D, Cîrstoiu M, Bohîlțea R, Vladareanu S, Patrascoiu S, Nastas AL, et al: The management of grade II/III hydronephrosis during pregnancy. Proceedings of Filodiritto Editore-Proceedings, the 13th National Congress of Urogynecology (UROGYN 2016): 195-199, 2016.
41	European Centre for Disease Prevention and Control: Geographical distribution of areas with a high prevalence of HTLV-1 infection. Stockholm, 2015 urihttps://www.ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/geographical-distribution-areas-high-prevalence-HTLV1.pdfsimplehttps://www.ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/geographical-distribution-areas-high-prevalence-HTLV1.pdf.