High prevalence of bronchiectasis is linked to HTLV-1-associated inflammatory disease.

Shohreh Honarbakhsh,Graham P Taylor

doi:10.1186/s12879-015-1002-0

Abstract

BackgroundHuman T-lymphotropic virus type 1 (HTLV-1), a retrovirus, is the causative agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL). The reported association with pulmonary disease such as bronchiectasis is less certain.MethodsA retrospective case review of a HTLV-1 seropositive cohort attending a national referral centre. The cohort was categorised into HTLV-1 symptomatic patients (SPs) (ATLL, HAM/TSP, Strongyloidiasis and HTLV associated inflammatory disease (HAID)) and HTLV-1 asymptomatic carriers (ACs). The cohort was reviewed for diagnosis of bronchiectasis.Result34/246 ACs and 30/167 SPs had been investigated for respiratory symptoms by computer tomography (CT) with productive cough +/- recurrent chest infections the predominant indications. Bronchiectasis was diagnosed in one AC (1/246) and 13 SPs (2 HAID, 1 ATLL, 10 HAM/TSP) (13/167, RR 19.2 95 % CI 2.5-14.5, p = 0.004) with high resolution CT. In the multivariate analysis ethnicity (p = 0.02) and disease state (p < 0.001) were independent predictors for bronchiectasis. The relative risk of bronchiectasis in SPs was 19.2 (95 % CI 2.5-14.5, p = 0.004) and in HAM/TSP patients compared with all other categories 8.4 (95 % CI 2.7-26.1, p = 0.0002). Subjects not of African/Afro-Caribbean ethnicity had an increased prevalence of bronchiectasis (RR 3.45 95 % 1.2-9.7, p = 0.02).ConclusionsBronchiectasis was common in the cohort (3.4 %). Risk factors were a prior diagnosis of HAM/TSP and ethnicity but not HTLV-1 viral load, age and gender. The spectrum of HTLV-associated disease should now include bronchiectasis and HTLV serology should be considered in patients with unexplained bronchiectasis.

Highlights

Human T-lymphotropic virus type 1 (HTLV-1), a retrovirus, is the causative agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL)
Risk factors were a prior diagnosis of HAM/TSP and ethnicity but not HTLV-1 viral load, age and gender
We have shown that patients with non-pulmonary HTLV-1-associated disease, inflammatory disease, are more likely to have an additional diagnosis of bronchiectasis than asymptomatic carriers and postulate that the same dysregulated hyper-inflammatory response seen in HTLV-associated myelopathy/tropical spastic paraparesis

Summary

Introduction

Human T-lymphotropic virus type 1 (HTLV-1), a retrovirus, is the causative agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL). The human T-lymphotropic virus type-1 (HTLV-1), a retrovirus, has been estimated to infect at least 5-10 million people worldwide with the highest prevalence reported in Japan, Africa, The Caribbean and South America [1] It is the causative agent of adult T-cell leukaemia/lymphoma (ATLL) [2], with a life-time risk of 3 – 7 % [3], of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) [4, 5] affecting up to 4 % of carriers [6] and of HTLV-1-associated uveitis [7]. Despite much higher VL in the cases than the matched controls this association is not maintained in the multivariate analysis [26] Further to this in a retrospective study of indigenous Australians with bronchiectasis HTLV-1 infection was associated with more extensive disease and more bronchiectasis-related deaths (OR 5.78 95 % CI 1.17 - 26.75, p 0.028) [28]. We conducted a retrospective study to describe the prevalence of, and factors associated with, a formal diagnosis of bronchiectasis

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