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Immune reconstitution inflammatory syndrome

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https://www.readbyqxmd.com/read/28646367/ifn%C3%AE-producing-cd4-t-lymphocytes-the-double-edged-swords-in-tuberculosis
#1
Pawan Kumar
IFNγ-producing CD4(+) T cells (IFNγ(+)CD4(+) T cells) are the key orchestrators of protective immunity against Mycobacterium tuberculosis (Mtb). Primarily, these cells act by enabling Mtb-infected macrophages to enforce phagosome-lysosome fusion, produce reactive nitrogen intermediates (RNIs), and activate autophagy pathways. However, TB is a heterogeneous disease and a host of clinical and experimental findings has also implicated IFNγ(+)CD4(+) T cells in TB pathogenesis. High frequency of IFNγ(+)CD4(+) T cells is the most invariable feature of the active disease...
December 2017: Clinical and Translational Medicine
https://www.readbyqxmd.com/read/28623673/a-prominent-lactate-peak-as-a-potential-key-magnetic-resonance-spectroscopy-mrs-feature-of-progressive-multifocal-leukoencephalopathy-pml-spectrum-pattern-observed-in-three-patients
#2
Duško Kozić, Mladen Bjelan, Jasmina Boban, Jelena Ostojić, Vesna Turkulov, Aleksandar Todorović, Slobodanka Lemajić-Komazec, Snežana Brkić
Progressive multifocal leukoencephalopathy (PML) is a rare, often fatal, opportunistic infection, associated with demyelinating process. PML is caused by John Cunningham (JC) polyomavirus, and predominantly involves patients with human immunodeficiency virus (HIV) disease or other immunocompromised conditions. The purpose of this report was to determine the role of magnetic resonance spectroscopy (MRS) in establishing the diagnosis of PML. MRS with long and short echo time was performed in two patients with PML associated with HIV infection and in one PML patient associated with chronic lymphocytic leukemia...
June 17, 2017: Bosnian Journal of Basic Medical Sciences
https://www.readbyqxmd.com/read/28617365/-immune-reconstitution-inflammatory-syndrome-and-rebound-syndrome-in-multiple-sclerosis-patients-who-stopped-disease-modification-therapy-current-understanding-and-a-case-report
#3
A N Belova, M V Rasteryaeva, N I Zhulina, E M Belova, A N Boyko
More and more multiple sclerosis patients have been receiving treatment with new immunomodulatory drugs. Its discontinuation because of side-effects, lack of efficacy or pregnancy has been increasing as well. This paper reviews such severe complications of natalizumab and fingolimod cessation as immune reconstitution inflammatory syndrome (IRIS) and rebound. The short history, immunopathogenesis and diagnostic criteria of IRIS in individuals with human immunodeficiency virus infection are covered. Clinical and radiological presentations as well as possible pathogenic mechanisms of IRIS in patients treated with natalizumab and fingolimod are discussed...
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/28614691/a-trial-of-itraconazole-or-amphotericin-b-for-hiv-associated-talaromycosis
#4
RANDOMIZED CONTROLLED TRIAL
Thuy Le, Nguyen Van Kinh, Ngo T K Cuc, Nguyen L N Tung, Nguyen T Lam, Pham T T Thuy, Do D Cuong, Pham T H Phuc, Vu H Vinh, Doan T H Hanh, Vu Van Tam, Nguyen T Thanh, Tran P Thuy, Nguyen T Hang, Hoang B Long, Ho T Nhan, Heiman F L Wertheim, Laura Merson, Cecilia Shikuma, Jeremy N Day, Nguyen V V Chau, Jeremy Farrar, Guy Thwaites, Marcel Wolbers
BACKGROUND: Talaromyces marneffei infection is a major cause of human immunodeficiency virus (HIV)-related death in South and Southeast Asia. Guidelines recommend initial treatment with amphotericin B deoxycholate, but this drug has substantial side effects, a high cost, and limited availability. Itraconazole is available in oral form, is associated with fewer unacceptable side effects than amphotericin, and is widely used in place of amphotericin; however, clinical trials comparing these two treatments are lacking...
June 15, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28588577/immune-reconstitution-inflammatory-syndrome-unmasking-or-worsening-aids-related-progressive-multifocal-leukoencephalopathy-a-literature-review
#5
REVIEW
Anna Fournier, Guillaume Martin-Blondel, Emmanuèle Lechapt-Zalcman, Julia Dina, Apolline Kazemi, Renaud Verdon, Emmanuel Mortier, Arnaud de La Blanchardière
Incidence of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients has declined in the combined antiretroviral therapy (cART) era although a growing number of acquired immunodeficiency syndrome (AIDS)-related PML-immune reconstitution inflammatory syndromes (PML-IRIS) have been published during the same period. Therapeutic management of PML-IRIS is not consensual and mainly relies on corticosteroids. Our main aim was, in addition to provide a thoughtful analysis of published PML-IRIS cases, to assess the benefit of corticosteroids in the management of PML-IRIS, focusing on confirmed cases...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28566170/is-maraviroc-useful-in-multiple-sclerosis-patients-with-natalizumab-related-progressive-multifocal-leukoencephalopathy
#6
Cristina Scarpazza, Luca Prosperini, Chiara R Mancinelli, Nicola De Rossi, Alessandra Lugaresi, Marco Capobianco, Lucia Moiola, Paola Naldi, Luisa Imberti, Simonetta Gerevini, Ruggero Capra
BACKGROUND: Despite the recent advances in the understanding of natalizumab (NTZ) related progressive multifocal leukoencephalopathy (PML) and its associated immune reconstitution inflammatory syndrome (PML-IRIS), the therapeutic options are still under investigated. In this context, the beneficial use of maraviroc is still an anecdotal observation. OBJECTIVE: To evaluate the impact of maraviroc in modifying the course of PML preventing IRIS or blunting IRIS manifestations...
July 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28558783/clinical-characteristics-predictors-of-immune-reconstitution-inflammatory-syndrome-and-long-term-prognosis-in-patients-with-kaposi-sarcoma
#7
Patricia Volkow, Gabriela Cesarman-Maus, Pamela Garciadiego-Fossas, Enrique Rojas-Marin, Patricia Cornejo-Juárez
OBJECTIVE: To investigate the predictive factors for the development of Kaposi sarcoma-related immune reconstitution inflammatory syndrome (KS-IRIS) and long-term prognosis in patients starting combined antiretroviral therapy (cART). METHODS: We studied a retrospective-cohort of consecutive antiretroviral-naïve patients with KS initiating cART from January 2005 to December 2011 and followed through June 2013. KS-IRIS was defined as ≥2 of the following: abrupt increase in number of KS lesions, appearance or exacerbation of lung-opacities or lymphedema, concomitantly with an increase in CD4+ cell-count ≥50 cells/mm(3) and a decrease of >1 log in viral-load once started cART...
May 30, 2017: AIDS Research and Therapy
https://www.readbyqxmd.com/read/28552210/immune-reconstitution-inflammatory-syndrome-iris-what-pathologists-should-know
#8
REVIEW
Ann Marie Nelson, Yukari C Manabe, Sebastian B Lucas
Antiretroviral therapy has significantly improved the quality and length of life for those patients able to access effective and sustained treatment. The resulting restoration of the immune response is associated with a change in the clinical presentation of opportunistic infections, and the histologic reaction to pathogens. A complex combination of alterations in host response across the stages of HIV infection has been documented over the past 3 decades. The defects are seen in both acute and chronic phases of inflammation and involve innate and adaptive immunity...
July 2017: Seminars in Diagnostic Pathology
https://www.readbyqxmd.com/read/28539969/erratum-to-hospital-days-attributable-to-immune-reconstitution-inflammatory-syndrome-in-persons-living-with-hiv-before-and-after-the-2012-dhhs-hiv-guidelines
#9
Peter Liu, Rebecca Dillingham, Kathleen A McManus
[This corrects the article DOI: 10.1186/s12981-017-0152-0.].
2017: AIDS Research and Therapy
https://www.readbyqxmd.com/read/28475709/matrix-degradation-in-human-immunodeficiency-virus-type-1-associated-tuberculosis-and-tuberculosis-immune-reconstitution-inflammatory-syndrome-a-prospective-observational-study
#10
Naomi F Walker, Katalin A Wilkinson, Graeme Meintjes, Liku B Tezera, Rene Goliath, Janique M Peyper, Rebecca Tadokera, Charles Opondo, Anna K Coussens, Robert J Wilkinson, Jon S Friedland, Paul T Elkington
Background.: Extensive immunopathology occurs in human immunodeficiency virus (HIV)/tuberculosis (TB) coinfection, but the underlying molecular mechanisms are not well-defined. Excessive matrix metalloproteinase (MMP) activity is emerging as a key process but has not been systematically studied in HIV-associated TB. Methods.: We performed a cross-sectional study of matrix turnover in HIV type 1 (HIV-1)-infected and -uninfected TB patients and controls, and a prospective cohort study of HIV-1-infected TB patients at risk of TB immune reconstitution inflammatory syndrome (TB-IRIS), in Cape Town, South Africa...
May 5, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28470016/relationship-of-human-immunodeficiency-virus-viral-load-in-cerebrospinal-fluid-and-plasma-in-patients-co-infected-with-cryptococcal-meningitis
#11
Christina C Chang, Richard Kangethe, Saleha Omarjee, Keshni Hiramen, Bernadett Gosnell, Katlego Sojane, Mohamed-Yunus S Moosa, Sharon R Lewin, Martyn A French, Thumbi Ndung'u
We measured human immunodeficiency virus (HIV) ribonucleic acid (RNA) in paired cerebrospinal fluid (CSF) and plasma samples in a prospective study of 91 HIV-infected, antiretroviral therapy-naive patients with cryptococcal meningitis. Cerebrospinal fluid HIV RNA was lower than in plasma (median 4.7 vs 5.2 log10 copies/mL, P < .0001) and positively correlated with plasma HIV RNA, peripheral CD4(+) T-cell percentage, and CSF CXCL10. Plasma/CSF ratio of HIV RNA ranged widely from 0.2 to 265.5 with a median of 2...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28469696/hospital-days-attributable-to-immune-reconstitution-inflammatory-syndrome-in-persons-living-with-hiv-before-and-after-the-2012-dhhs-hiv-guidelines
#12
Peter Liu, Rebecca Dillingham, Kathleen McManus
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) can manifest with initiation or reintroduction of antiretroviral therapy (ART) in persons living with HIV (PLWH). In 2012, updated United States treatment guidelines recommended initiation of ART for all PLWH regardless of CD4 count. The objectives of this study were to quantify hospital usage attributable to IRIS and assess the reasons for hospitalization in PLWH before and after the guideline update. METHODS: Subjects were PLWH between 18-89 years of age who were hospitalized between November 1, 2009 and July 31, 2014...
2017: AIDS Research and Therapy
https://www.readbyqxmd.com/read/28464903/hospital-days-attributable-to-immune-reconstitution-inflammatory-syndrome-in-persons-living-with-hiv-before-and-after-the-2012-dhhs-hiv-guidelines
#13
Peter Liu, Rebecca Dillingham, Kathleen McManus
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) can manifest with initiation or reintroduction of antiretroviral therapy (ART) in persons living with HIV (PLWH). In 2012, updated United States treatment guidelines recommended initiation of ART for all PLWH regardless of CD4 count. The objectives of this study were to quantify hospital usage attributable to IRIS and assess the reasons for hospitalization in PLWH before and after the guideline update. METHODS: Subjects were PLWH between 18-89 years of age who were hospitalized between November 1, 2009 and July 31, 2014...
May 2, 2017: AIDS Research and Therapy
https://www.readbyqxmd.com/read/28438129/severe-type-1-upgrading-leprosy-reaction-in-a-renal-transplant-recipient-a-paradoxical-manifestation-associated-with-deficiency-of-antigen-specific-regulatory-t-cells
#14
Ana Paula Vieira, Maria Angela Bianconcini Trindade, Flávio Jota de Paula, Neusa Yurico Sakai-Valente, Alberto José da Silva Duarte, Francine Brambate Carvalhinho Lemos, Gil Benard
BACKGROUND: Due to its chronic subclinical course and large spectrum of manifestations, leprosy often represents a diagnostic challenge. Even with proper anti-mycobacteria treatment, leprosy follow up remains challenging: almost half of leprosy patients may develop reaction episodes. Leprosy is an infrequent complication of solid organ transplant recipients. This case report illustrates the challenges in diagnosing and managing leprosy and its reactional states in a transplant recipient...
April 24, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28399724/the-epidemiology-of-iris-in-southern-india-an-observational-cohort-study
#15
Nisha Thambuchetty, Kayur Mehta, Karthika Arumugam, Umadevi G Shekarappa, Jyothi Idiculla, Anita Shet
Immune reconstitution inflammatory syndrome (IRIS) is an uncommon but dynamic phenomenon seen among patients initiating antiretroviral therapy (ART). We aimed to describe incidence, risk factors, clinical spectrum, and outcomes among ART-naive patients experiencing IRIS in southern India. Among 599 eligible patients monitored prospectively between 2012 and 2014, there were 59.3% males, with mean age 36.6 ± 7.8 years. Immune reconstitution inflammatory syndrome incidence rate was 51.3 per 100 person-years (95% confidence interval: 44...
January 1, 2017: Journal of the International Association of Providers of AIDS Care
https://www.readbyqxmd.com/read/28393665/the-first-report-of-bartonella-quintana-immune-reconstitution-inflammatory-syndrome-complicated-by-jarisch-herxheimer-reaction
#16
Michelle DallaPiazza, Matthew Jiro Akiyama
Bacillary angiomatosis (BA) is a rare complication of human immune deficiency virus (HIV) infection in the post-antiretroviral therapy (ART) era, and few cases of BA-associated immune reconstitution inflammatory syndrome (IRIS) have been described. We report the case of a 50-year-old man who presented with mass lesions involving the skin, subcutaneous tissues, muscle, and bone. The diagnosis of Bartonella quintana BA was confirmed by serum polymerase chain reaction. The patient's treatment course was complicated by both IRIS and Jarisch-Herxheimer reaction...
January 1, 2017: Journal of the International Association of Providers of AIDS Care
https://www.readbyqxmd.com/read/28375874/immune-reconstitution-inflammatory-syndrome-associated-with-toxoplasmic-encephalitis-in-hiv-infected-patients
#17
Ward P H van Bilsen, Charlotte H S B van den Berg, Bart J A Rijnders, Kees Brinkman, Jan W Mulder, Luc B S Gelinck, Andy I M Hoepelman, Ferdinand W N M Wit, Diederik van de Beek, Jan M Prins
OBJECTIVES: To investigate the incidence and risk factors of immune reconstitution inflammatory syndrome (IRIS) associated with toxoplasmic encephalitis (TE) in patients starting combination antiretroviral therapy (cART). DESIGN: A historical multicenter cohort study. METHODS: We included all HIV-infected patients diagnosed with toxoplasmic encephalitis in six Dutch hospitals between 1996 and 2016. Diagnosis of TE-IRIS was made using predefined IRIS criteria...
June 19, 2017: AIDS
https://www.readbyqxmd.com/read/28372806/multiple-immune-disorders-after-natalizumab-discontinuation-after-the-ciris-the-siris
#18
E K Van Obberghen, M Cohen, F Rocher, C Lebrun-Frenay
Natalizumab (NTZ) is an effective treatment for patients with highly active relapsing remitting multiple sclerosis (MS). However, when the therapy must be interrupted, it is important to anticipate the withdrawal to avoid reactivation or disease rebound. Described here is the case of a 35-year-old woman, with a past history of beta thalassemia, bulimia and asthma, who was diagnosed with MS at age 26. She was treated initially with first-line subcutaneous (sc) immunomodulatory treatments. However, due to liver toxicity, interferon beta-1a sc was interrupted and replaced by glatiramer acetate treatment, which was well tolerated and used for several years...
March 31, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28367350/immune-reconstitution-inflammatory-syndrome-occurring-in-a-kidney-transplant-patient-with-extrapulmonary-tuberculosis
#19
Jose Iglesias, Kandria Jumil Ledesma, Paul J Couto, Jessie Liu
Tuberculosis (TB) occurring in solid organ transplantation (SOT) is associated with significant morbidity and mortality usually due to delays in diagnosis, drug toxicity encountered with antimycobacterial therapy, and drug-drug interactions. TB in SOT patients may mimic other infectious and noninfectious posttransplant complications such as posttransplant lymphoproliferative disorder (PTLD) and systemic cytomegalovirus infection. Immune reconstitution inflammatory syndrome (IRIS) is a host response resulting in paradoxical worsening of an infectious disease which occurs after the employment of effective therapy and reversal of an immunosuppressed state...
2017: Case Reports in Transplantation
https://www.readbyqxmd.com/read/28362522/multiple-sclerosis-update-use-of-mri-for-early-diagnosis-disease-monitoring-and-assessment-of-treatment-related-complications
#20
REVIEW
Mark S Igra, David Paling, Mike P Wattjes, Daniel J A Connolly, Nigel Hoggard
MRI has long been established as the most sensitive in vivo technique for detecting multiple sclerosis (MS) lesions. The 2010 revisions of the McDonald Criteria have simplified imaging criteria, such that a diagnosis of MS can be made on a single contrast-enhanced MRI scan in the appropriate clinical context. New disease-modifying therapies have proven effective in reducing relapse rate and severity. Several of these therapies, most particularly natalizumab, but also dimethyl fumarate and fingolimod, have been associated with progressive multifocal leukoencephalopathy (PML)...
June 2017: British Journal of Radiology
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