Uveitis due to human T lymphocyte type I
Introduction
Introduction to uveitis caused by type T lymphocytes Human T-lymphotropic virus (HTLV) is a retrovirus that has been found to be type 3, namely HTLV-I, HTLV-II and HTLV-III. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: retinal vasculitis
Cause
The cause of uveitis caused by human T lymphocyte type I
(1) Causes of the disease
Human T-lymphotropic virus type I (human T-lymphotropic virus type I) is a human retrovirus that causes two systemic diseases of adult T cell leukemia and HTLV-I related myelopathy. In recent years, it has been shown to be a human T lymphocyte. Cellular virus type I can cause endogenous uveitis, which is called HTLV-I associtted uveitis (HAU).
(two) pathogenesis
It is unclear whether the onset of human T-lymphocyte virus type I-associated uveitis is due to a direct response by infected cells or a virus-infected T cell-mediated autoimmune response or other. The following evidence supports the disease. The occurrence is more likely to be an autoimmune process: 1 CD4-positive T lymphocytes known to be infected with human T-lymphocyte virus type I express the interleukin-2 receptor and produce various lymphokines; 2 anterior chamber of uveitis patients Infected lymphocytes can be detected by PCR; 3 patients with positive serological tests respond well to corticosteroid treatment; 4 patients have a history of Grave disease.
Prevention
Uveitis prevention caused by human T lymphocyte type I
Uveitis caused by human T lymphocyte type I is mainly human T lymphocyte virus type I (hum is a human retrovirus, causing both adult T cell leukemia and HTLV-I related myelopathy) Sick, so we must actively promote a safe sex life, cut off the route of transmission. Mainly do a good job of prevention. Actively exercise, enhance physical fitness, prevent colds, eat less irritating food, pay attention to work and rest, maintain physical and mental health, prevent this disease It also has important significance.
Complication
Uveitis complications caused by human T lymphocyte type I Complications retinal vasculitis
Retinal vasculitis is more common.
Symptom
Trachomic inflammatory disease caused by human T lymphocyte type I common symptoms leukocytosis bladder dysfunction nodular lymph node enlargement ciliary congestion
Whole body performance
The human T lymphocyte virus type I has been identified to cause a T cell malignancy (adult T cell leukemia) and a chronic myelopathy.
(1) adult T-cell leukemia: only occurs in adults, typical cases are acute or subacute, liver, spleen lymph nodes, but the thymus is not invaded, there are systemic or localized skin lesions, such as erythroderma, knot Festival, etc., anemia is relatively light, leukocytosis, to 26,000 ~ 85,000, and some even up to 100,000, with a special nuclear shape of lymphocytes for outstanding performance, the percentage of myeloid leukemia cells is lower than the general leukemia, patient cellular immune function Low, often lead to conditional pathogen infections, such as opportunistic infections of the lungs, chronic renal failure, non-specific dermatophytosis, etc., patients with poor prognosis.
(2) T-type lymphocytic virus type I-related myelopathy: a chronic neurological disorder mainly characterized by spastic spinal cord paralysis. Females are slightly more than males, mostly occurring in 30 to 40 years old, and can also be found in children and the elderly. Slow onset, manifested as spastic symmetry paralysis, lower limb muscle strength, bladder dysfunction, sensory and vibrational disturbances, hyperreflexia, alveolitis, joint dyskinesia, uveitis.
2. Human T lymphocyte virus type I-related uveitis
The human T-lymphocyte virus type I can cause associated uveitis without systemic disease.
(1) T-cell leukemia with HTVL-I uveitis: This may be uveitis caused by two mechanisms: 1 tumor cells directly infiltrate into the eye; 2 cause opportunistic infection when the patient's immune function is low And cause uveitis.
(2) HTLV-I-related uveitis associated with HTLV-I: in addition to common retinal vasculitis, can be complicated by uveitis, mostly acute or subacute onset, showing mild granulomatous Uveitis, vitreous granules or membranous opacity, monocular or binocular onset, recurrence, not necessarily associated with neurological symptoms.
(3) Uveitis caused by HTLV-I: In recent years, studies have confirmed that HTLV-I can cause uveitis without systemic disease, because the infection rate of unexplained uveitis HTLV-I is more obvious than the cause of uveitis. Significant increase, hence the name of human T lymphocyte virus type I-related uveitis, the age of onset of human T-lymphocyte virus type I-related uveitis is 19 to 75 years old, with an average age of 46 years, with Japan The researchers reported that women in the 20 to 29 years old and 50 to 59 years old peak incidence, thought that may be related to the obvious internal environment such as sex hormones and pregnancy changes in the two age groups, its clinical features are mild clinical manifestations such as the front Floating objects, fog, or acute or subacute vision loss, can occur in one or both eyes, patients with mild ciliary congestion, corneal KP after cornea, mild or moderate floating cells in the anterior chamber, white hole in the pupil Soft nodules, iris rarely appear before and after adhesion, vitreous is mild or moderate opacity, retinal vascular white sheath, and visible turbid surface of the retina, occasionally visible retinal choroidal exudation and atrophy, most suffering With intermediate uveitis, manifested as vitreous opacity and mild retinal vasculitis, a small number of patients with only iritis or uveitis with uveal retinopathy, uveitis is chronic progressive, human T lymphocytes Viral type I-related uveitis has the following conditions:
1 middle-aged healthy adults with single or double eyes, subacute uveitis, foggy and floating mosquitoes.
2 active period is accompanied by vitreous opacity (88%), granulomatous or non-granulomatous anterior uveitis, the former is more than the latter; retinal vasculitis, white sheath or white spot attachment; cholinoretinal diagnosis of less lesions .
3 better response to local or systemic hormone therapy.
4 visual prognosis is generally good, most patients have complete recovery of vision.
5 very few recurrences.
Examine
Examination of uveitis caused by human T lymphocyte type I
Dynamic serum antibody assays, as well as detection of HLTV-I DNA using polymerase chain reaction (PCR).
Slit lamp examination can determine the nature and extent of anterior segment lesions. Fluorescein fundus angiography can indicate the presence of retinal vasculitis and its extent.
Diagnosis
Diagnosis and differentiation of uveitis caused by type I T lymphocytes
diagnosis
HTLV-I infected patients have obvious regional distribution characteristics. When uveitis is encountered in high-incidence areas, the possibility of such virus should be considered. Dynamic serum antibody assay and PCR detection are helpful for diagnosis. Eliminate other causes and other types of uveitis.
Differential diagnosis
1. Behcet's disease, human T lymphotropic virus type I-associated uveitis and Behcet's disease can be characterized by diffuse retinal vasculitis, but the retinal vasculitis caused by the former is mild, rarely accompanied by retinal hemorrhage and exudation There will be no anterior chamber empyema, while the latter has systemic changes such as oral and genital ulcers, skin changes and so on.
2. Toxoplasmosis T-lymphocyte virus type I-associated uveitis does not cause retinal necrosis, which can be differentiated from toxoplasmosis caused by retinal necrosis.
3. Sarcoidosis, human T lymphocyte virus type I-related uveitis and sarcoidosis can cause granulomatous uveitis, but the latter can have chest X-ray abnormalities, serum angiotensin-converting enzyme levels rise High, but the former does not.
4. The identification of human T lymphocyte virus type I-related uveitis and Vogt-Koyanagi-Harada syndrome, tuberculosis, syphilis or rheumatism can be identified according to different systemic changes.
