title: Rapid development of subacute myelopathy in three organ transplant recipients after transmission of human T-cell lymphotropic virus type I from a single donor.
abstract: BACKGROUND
  Human T-cell lymphotropic virus type I (HTLV-I) causes a subacute myelopathy in less than 5% of chronic carriers. However, the risk of neurologic disease appears to increase in persons infected through blood transfusion.
  
  
  METHODS
  We report three recipients of solid organ transplants who developed a subacute myelopathy within 2 years after becoming infected with HTLV-I from a single asymptomatic HTLV-I donor. Genetic studies were performed in and sequences in proviral DNA, and HTLV-I proviral load was measured by real-time quantitative polymerase chain reaction.
  
  
  RESULTS
  HTLV-I sequences were obtained in two of these individuals, and they were almost identical and clustered within the Cosmopolitan A HTLV-I subtype, which indicates a common source. All typical changes in Tax amino acid sequence of the HTLV-I Cosmopolitan A were identified, plus two additional changes were noted. Although A has been associated with a greater risk of neurologic disease, both patients were positive for human leukocyte antigen-A*02, which is considered a protective factor.
  
  
  CONCLUSIONS
  Rapid development of subacute myelopathy may occur in recipients of organ transplants from asymptomatic HTLV-I donors. A particular virulence of the virus strain, the large size of the virus inoculum, and the immunosuppressed condition after transplantation may have contributed to produce this unusual rapid development of HTLV-I associated myelopathy.
authors.affiliation: Service of Infectious Diseases, Hospital Carlos III, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Toro
authors.forename: Berta
authors.initials: B
authors.lastname: Rodés
authors.forename: Eva
authors.initials: E
authors.lastname: Poveda
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
mesh_terms: D000328:Adult; D001483:Base Sequence; D005260:Female; D015490:HTLV-I Infections / Q000635:transmission* / Q000821:virology; D015368:Human T-lymphotropic virus 1 / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D015493:Paraparesis, Tropical Spastic / Q000209:etiology*; D014019:Tissue Donors; D019562:Viral Load