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Immune reconstitution inflammatory syndrome

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https://www.readbyqxmd.com/read/28791872/mycobacterium-avium-complex-infection-and-immune-reconstitution-inflammatory-syndrome-remain-a-challenge-in-the-era-of-effective-antiretroviral-therapy
#1
Olivia C Smibert, Jason Trubiano, Gail B Cross, Jennifer Hoy
A 10-year review of disseminated MAC infection and MAC-Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-positive patients (2004-2014) at a state-wide tertiary referral HIV service, demonstrates that despite advances in antiretroviral therapy, MAC infection remains a therapeutic challenge, particularly intra-abdominal disease.
August 9, 2017: AIDS Research and Human Retroviruses
https://www.readbyqxmd.com/read/28757763/immune-reconstitution-inflammatory-syndrome-associated-disseminated-kaposi-s-sarcoma-in-a-patient-infected-with-human-immunodeficiency-virus-report-of-an-autopsy-case
#2
Chiu-Hsuan Cheng, Yung-Hsiang Hsu
Immune reconstitution inflammatory syndrome is a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes following the initiation of highly active antiretroviral therapy (HAART) in individuals infected with human immunodeficiency virus (HIV). It involves a wide range of pathogens, neoplasms such as Kaposi's sarcoma (KS) and some autoimmune diseases. We describe an autopsy report of a 40-year-old man infected with HIV. He experienced a rapid dissemination of KS resulting in death within 6 months after starting HAART...
January 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/28747447/long-term-aids-related-pcnsl-outcomes-with-hd-mtx-and-combined-antiretroviral-therapy
#3
Antoine Moulignier, Cédric Lamirel, Hervé Picard, Marie-Gisèle Lebrette, Corinne Amiel, Mohammed Hamidi, Marc Polivka, Jacqueline Mikol, Isabelle Cochereau, Gilles Pialoux
OBJECTIVE: To assess the characteristics and outcomes of patients with AIDS-related primary CNS lymphoma (AR-PCNSL) in the combined antiretroviral therapy (cART) era systematically treated with high-dose methotrexate (HD-MTX). METHODS: We retrospectively analyzed (intention-to-treat analysis) 51 consecutive patients with AR-PCNSL (median age 39 years) who were diagnosed from 1996 to 2014 and treated with a median of 6 (range 1-15) infusions of HD-MTX (3 g/m(2)) combined with cART...
July 26, 2017: Neurology
https://www.readbyqxmd.com/read/28736762/confusion-in-the-study-of-immune-reconstitution-inflammatory-syndrome
#4
Claudia Alvarado-de la Barrera, Gustavo Reyes-Terán
As a consequence of late presentation for HIV care, a significant proportion of individuals develop immune reconstitution inflammatory syndrome (IRIS) soon after initiation of antiretroviral therapy. Incidence, predictors, and models of pathogenesis of IRIS vary in the literature. Here we discuss factors that may contribute to this lack of consensus. We propose that different pathogens drive different types of IRIS and suggest that these clinical conditions should be studied individually and not grouped under the general heading of "IRIS...
2017: Pathogens & Immunity
https://www.readbyqxmd.com/read/28713662/subacute-sclerosing-panencephalitis-in-a-child-suffering-from-human-immunodeficiency-virus-on-highly-active-antiretroviral-therapy-can-this-be-another-instance-of-immune-reconstitution-inflammatory-syndrome
#5
Ashutosh Gupta, Suman Kushwaha, Mushbiq Manzoor, Shah Faisal Ahmad Tarfarosh
We report a 12-year-old boy with human immunodeficiency virus (HIV) who presented with rapidly progressive difficulty in ambulation. The symptoms started to worsen when he was put on antiretroviral therapy (ART). Our findings show that the dynamics of HIV-related immune suppression and highly active antiretroviral therapy (HAART) have an impact on the clinical course of Subacute sclerosing panencephalitis (SSPE). Slow progression is expected in children on HAART but in our case, we observe a complex interaction of the virus with the immune system and modification of disease course of SSPE with ART...
June 13, 2017: Curēus
https://www.readbyqxmd.com/read/28687688/contribution-of-arterial-spin-labelling-mri-in-a-case-with-immune-reconstitution-inflammatory-syndrome
#6
Noriaki Wada, Tomoyuki Noguchi, Takahiro Aoki, Tsuyoshi Tajima
Central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS), which occurs most often in HIV-infected patients, is an exacerbation of inflammatory reactions related to opportunistic infections as well as primary CNS malignancies both of which mostly occur in HIV-infected patients. However, differential diagnoses are challenging both clinically and radiologically. We describe a patient with CNS-IRIS due to toxoplasmosis whose (11)C-methionine uptake suggested lymphoma but whose arterial spin-labelling MRI led to the correct diagnosis...
July 6, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28681821/risk-factors-and-frequency-of-tuberculosis-associated-immune-reconstitution-inflammatory-syndrome-among-hiv-tuberculosis-co-infected-patients-in-southern-india
#7
Ramachandran Vignesh, Chinnambedu R Swathirajan, Sunil S Solomon, Esaki Muthu Shankar, Kailapuri G Murugavel
Immune reconstitution inflammatory syndrome (IRIS) continues to be a complication in HIV/tuberculosis (TB) co-infected patients initiating highly active antiretroviral therapy (HAART). The aim of this study was to evaluate the risk factors associated with developing IRIS to identify a possible biomarker to predict or diagnose IRIS in patients initiating HAART. A total of 175 HIV/TB co-infected patients initiating HAART were followed up longitudinally during September 2010 to May 2013 attending a HIV care clinic in Chennai...
April 2017: Indian Journal of Medical Microbiology
https://www.readbyqxmd.com/read/28674518/brain-susceptibility-changes-in-a-patient-with-natalizumab-related-progressive-multifocal-leukoencephalopathy-a-longitudinal-quantitative-susceptibility-mapping-and-relaxometry-study
#8
Giuseppe Pontillo, Sirio Cocozza, Roberta Lanzillo, Pasquale Borrelli, Anna De Rosa, Vincenzo Brescia Morra, Enrico Tedeschi, Giuseppe Palma
BACKGROUND: Brain MRI plays an essential role in both diagnosis and follow-up of the JC virus infection of the brain. Recently, MR studies with susceptibility-weighted imaging (SWI) sequences have shown hypointensities in U-fibers adjacent to white matter (WM) lesions of progressive multifocal leukoencephalopathy (PML). This finding has been confirmed with the use of quantitative susceptibility mapping (QSM), allowing to hypothesize a paramagnetic effect in these regions. Here, we report the first longitudinal assessment of QSM and R2* maps in natalizumab-associated PML to evaluate serial changes in susceptibility contrast images and their role in PML diagnosis and follow-up...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28659366/successful-repeat-ecmo-in-a-patient-with-aids-and-ards
#9
Sho Horikita, Masamitsu Sanui, Yuki Fujimoto, Alan Kawarai Lefor
Veno-venous extracorporeal membrane oxygenation (ECMO) is being more commonly used in patients with acute respiratory distress syndrome (ARDS) due to potentially reversible illnesses. Survival from ARDS using ECMO has been reported even in patients with AIDS. However, the indications for ECMO for ARDS due to immune reconstitution inflammatory syndrome (IRIS) in patients with AIDS are unknown. A 23-year-old man with AIDS and Pneumocystis jirovecii pneumonia was admitted to the intensive care unit with severe ARDS refractory to mechanical ventilator support requiring ECMO...
June 28, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28646367/ifn%C3%AE-producing-cd4-t-lymphocytes-the-double-edged-swords-in-tuberculosis
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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