HTLV-1 infection in solid organ transplant donors and recipients in Spain

HTLV-1 infection is a neglected disease, despite infecting 10-15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy

Rapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals

Two kidney transplant recipients from a single donor became infected with HTLV-1 (human T-lymphotropic virus type 1) in Spain. One developed myelopathy 8 months following surgery despite early prescription of antiretroviral therapy. The allograft was removed from the second recipient at month 8 due to rejection and immunosuppressors discontinued. To date, 3 years later, this patient remains infected but asymptomatic. HTLV-1 infection was recognized retrospectively in the donor, a native Spaniard who had sex partners from endemic regions. Our findings call for a reappraisal of screening policies on donor–recipient organ transplantation. Based on the high risk of disease development and the large flux of persons from HTLV-1 endemic regions, pre-transplant HTLV-1 testing should be mandatory in Spain

Rapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals

Two kidney transplant recipients from a single donor became infected with HTLV-1 (human T-lymphotropic virus type 1) in Spain. One developed myelopathy 8 months following surgery despite early prescription of antiretroviral therapy. The allograft was removed from the second recipient at month 8 due to rejection and immunosuppressors discontinued. To date, 3 years later, this patient remains infected but asymptomatic. HTLV-1 infection was recognized retrospectively in the donor, a native Spaniard who had sex partners from endemic regions. Our findings call for a reappraisal of screening policies on donor–recipient organ transplantation. Based on the high risk of disease development and the large flux of persons from HTLV-1 endemic regions, pre-transplant HTLV-1 testing should be mandatory in Spain

Estudio epidemiológico y clínico de las infecciones pulmonares por Mycoplasma pneumoniae

Introduction:Due to the high prevalence of M. pneumoniaeinfection in the etiology of childhood pneumonia a retrospectivestudy of an outbreak of pneumonia due to this organism occurred in children under 14 years and admitted to Hospital InfantilUniversitario Miguel Servet is performed in order to describe their epidemiological and clinical characteristics.Material andmethods:Medical records of hospitalized patients treated in the period from May to August 2010 were reviewed. 21 casesof pneumonia were caused by M. pneumoniaeand diagnosed by Mycoplasma InmnunoCard EIA with positive IgM.Results:There was a higher incidence in females (66.6%) and children older than 5 years (76%). Fever, cough and rhinitis were thesymptoms more frequently found. In the chest x-ray, the consolidation was the image more predominant (90.5%), multifocalpresentation was found in 33.3% of patients. The analytical results showed neutrophilia of >70% in 47% of cases.Conclusions:Pneumonia caused by M. pneumoniaewas observed mainly in female and older than 5 years.The clinic wasvery variable but fever and cough were prevalent. Radiological studies showed consolidation and laboratory data were nonspecific. For diagnosis it is important to consider the cases of pneumonia not responding to a previous antibiotic therapy.Introducción:Debido a la alta prevalencia de la infección por Mycoplasma pneumoniaeen la etiología de la neumoníainfantil se realiza un estudio retrospectivo de un brote de neumonía debido a este microorganismo ocurrido enmenores de 14 años e ingresados en el Hospital Universitario Infantil Miguel Servet con el objetivo de describirsus características epidemiológicas y clínicas.Material y métodos:Se realiza un estudio retrospectivo mediante larevisión de las historias clínicas de los pacientes ingresados atendidos en el período de mayo a agosto de 2010.Fueron diagnosticados 21 casos de neumonía por M. pneumoniaediagnosticados mediante EIA InmnunoCard My-coplasma con IgM positiva.Resultados:Se observó una mayor incidencia en el sexo femenino (66,6%) y en mayoresde 5 años (76%). Fiebre, tos y rinitis fueron los síntomas más frecuentemente encontrados. En la radiografía detórax la consolidación fue la imagen predominante (90,5%). La presentación multifocal se encontró en el 33,3% delos casos. Los resultados analíticos mostraron una neutrofilia >70% en el 47% de los casos.Conclusiones:Laneumonía por M.pneumoniaese observó fundamentalmente en el sexo femenino y en mayores de 5 años.La clínicafue muy variable y fueron prevalentes la fiebre y la tos, radiológicamente predominaron las formas consolidativas ylos resultados analíticos fueron inespecíficos. Para el diagnóstico es importante valorar los casos de neumonía queno responden a la antibioterapia

HTLV-1 infection in solid organ transplant donors and recipients in Spain

Background: HTLV-1 infection is a neglected disease, despite infecting 10–15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. Methods: All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. Results: A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. Conclusion: The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy

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