Introduction

Accidental exposure to blood and other biological fluids in the workplace entails a risk of transmission to various microorganisms. The human T-cell lymphotropic virus (HTLV) is a retrovirus with four known subtypes, with type 1 and 2 being the most studied. It is transmitted vertically, sexually and hematogenous. Subtype 1 causes disease in humans and can be associated with the development of Adult T-Cell Leukemia/Lymphoma or HTLV-1-associated myelopathy. Blood-borne transmission makes this agent a potential source of infection for healthcare workers in the context of work-related accidents with exposure to blood and other biological fluids. Although it is not particularly prevalent on the European continent, the risk of exposure may exist in the context of workers who carry out their work in endemic areas or gain relevance in the context of increased migratory flows at a global level.

Case report

This is the case of a 32-year-old doctor, with no relevant personal history, who, during an internship in a hospital unit other than his usual one, suffered an accidental puncture, with exposure to blood, while performing a surgical procedure on a patient infected with HTLV-1/2. The source's other viral serologies (HBV, HCV, HIV) were negative, but the patient's health condition at the time was unknown, specifically there was no data to inform on the viral load. Furthermore, the subtype of HTLV with which she was infected was not identified. As there is no evidence of the efficacy of post-exposure prophylaxis, the worker was kept under surveillance for three months, and a serological test was carried out at the end of the follow-up period, which was negative.

Discussion/Conclusion

Blood-borne transmission of HTLV, either by blood transfusions from infected donors or by the sharing of needles in intravenous drug users, is well documented, so it is biologically plausible for transmission to occur by accidental cut or through a puncture wound in the occupational environment. However, since transmission depends on cell-to-cell contact, there needs to be a sufficient volume of infected blood or biological fluids to allow cells to pass from the source to the victim. Both for this reason and because of the various limitations in the few studies available on this subject, focusing on the workplace, the only systematic review published concluded that there is no evidence to significantly prove seroconversion after exposure in this setting. In this clinical case, it was decided to keep the worker under surveillance and carry out a serology at three months post-exposure. It was considered that, although there is no scientific evidence to this effect, given the possibility of transmission and the seriousness of the effects in the case of HTLV-1, it is reasonable to carry out this follow-up as cases of seroconversion should be reported as an occupational disease. This would be even more important if the accident had occurred to a female healthcare worker of childbearing age, since seroconversion would raise the possibility of secondary transmission to her offspring, and there would be an indication to avoid breastfeeding.

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