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Immune reconstitution syndrome

Jayne P Ellis, Newton Kalata, Elizabeth C Joekes, Samuel Kampondeni, Laura A Benjamin, Thomas S Harrison, David G Lalloo, Robert S Heyderman
BACKGROUND: Cryptococcal meningitis remains the leading cause of adult meningitis in Sub-Saharan Africa. Immune Reconstitution Inflammatory Syndrome (IRIS) following anti-retroviral therapy (ART) initiation is an important complication. Here we report the first documented case of a IRIS reaction presenting as an ischemic stroke. CASE PRESENTATION: A 38 year old newly diagnosed HIV-infected, ART naive Malawian male presented to a tertiary referral hospital in Blantyre, Malawi with a 2 week history of headache...
October 16, 2018: BMC Infectious Diseases
Tyler Finocchio, William Coolidge, Thomas Johnson
The management of patients with human immunodeficiency virus (HIV) can be a complicated specialty within itself, made even more complex when there are so many unanswered questions regarding the care of critically ill patients with HIV. The lack of consensus on the use of antiretroviral medications in the critically ill patient population has contributed to an ongoing clinical debate among intensivists. This review focuses on the pharmacological complications of antiretroviral therapy (ART) in the intensive care setting, specifically the initiation of ART in patients newly diagnosed with HIV, immune reconstitution inflammatory syndrome (IRIS), continuation of ART in those who were on a complete regimen prior to intensive care unit admission, barriers of drug delivery alternatives, and drug-drug interactions...
October 11, 2018: Journal of Intensive Care Medicine
Muharrem Muftuoglu, Amanda Olson, David Marin, Sairah Ahmed, Victor Mulanovich, Sudhakar Tummala, T Linda Chi, Alessandra Ferrajoli, Indreshpal Kaur, Li Li, Richard Champlin, Elizabeth J Shpall, Katayoun Rezvani
JC virus, the cause of progressive multifocal leukoencephalopathy (PML), and the BK virus are genetically similar and share sequence homology in immunogenic proteins. We treated three immunosuppressed patients with PML with ex vivo-expanded, partially HLA-matched, third-party-produced, cryopreserved BK virus-specific T cells. The immunosuppression in these patients was due to the conditioning regimen for cord-blood transplantation in one patient, a myeloproliferative neoplasm treated with ruxolitinib in another, and acquired immunodeficiency syndrome in the third...
October 11, 2018: New England Journal of Medicine
Antoine Gaillet, Ruxandra Calin, Sebastien Imbert, Morgan Ollivier, Helene Guillot, Arnaud Fekkar, Valerie Pourcher
No abstract text is available yet for this article.
October 23, 2018: AIDS
Joseph R Zunt
PURPOSE OF REVIEW: This article details the epidemiology and clinical manifestations of central nervous system (CNS) tuberculosis (TB), provides guidance for diagnostic imaging and CSF testing, and recommends treatment strategies for tuberculous meningitis and other forms of CNS TB, illustrating key aspects of diagnosis and management with case presentations. RECENT FINDINGS: Although improvements in our understanding of the pathogenesis and management of CNS TB have occurred over the past 50 years, the emergence of multidrug-resistant and extensively drug-resistant TB, the advent of acquired immunodeficiency syndrome (AIDS), and the subsequent availability of highly active antiretroviral therapy that can produce the immune reconstitution inflammatory syndrome have complicated the diagnosis and treatment of CNS TB...
October 2018: Continuum: Lifelong Learning in Neurology
Hilte F Geerdes-Fenge, Micha Löbermann, Christoph J Hemmer, Orsolya Benedek, Emil C Reisinger
A 22-year-old HIV-negative man from Ghana was diagnosed with severe hemophagocytic lymphohistiocytosis (HLH) induced by multiorgan tuberculosis with peritoneal, hepatic, pericardial, myocardial, pleural, pulmonary, and bone manifestation. His body mass index was 12.9 m2 /kg. Bioptic material of a peritoneal biopsy grew M. tuberculosis, sensitive to all first-line antituberculous drugs. HLH resolved with antituberculous therapy, without additional anti-inflammatory therapy being given. The initial CT scan of his brain was normal...
September 26, 2018: Infection
Lea Bottlaender, Pascal Sève, Laurent Cotte, Mathieu Gerfaud-Valentin, Yvan Jamilloux
No abstract text is available yet for this article.
September 19, 2018: Rheumatology
Martin Alexander Schaller, Felix Wicke, Christian Foerch, Stefan Weidauer
PURPOSE: As a result of multilateral migration and globalization in times of humanitarian crises, western countries face a possible increase in the incidence of central nervous system tuberculosis (CNS TB). The diagnosis of CNS TB is challenging and often delayed due to the manifold and often non-specific presentation of the disease. The aim of this review is to analyze and summarize imaging features and correlated clinical findings of CNS TB. METHODS: The different manifestations of CNS TB are explained and illustrated by characteristic neuroradiological as well as neuropathological findings...
September 17, 2018: Clinical Neuroradiology
Dima A Hammoud, Afroditi Boulougoura, Georgios Z Papadakis, Jing Wang, Lori E Dodd, Adam Rupert, Jeanette Higgins, Gregg Roby, Dorinda Metzger, Elizabeth Laidlaw, JoAnn M Mican, Alice Pau, Silvia Lage, Chun-Shu Wong, Andrea Lisco, Maura Manion, Virginia Sheikh, Corina Millo, Irini Sereti
Background: Immune reconstitution inflammatory syndrome (IRIS) represents an unexpected inflammatory response shortly after initiation of antiretroviral therapy (ART) in some human immunodeficiency virus (HIV)-infected patients with underlying neoplasia or opportunistic infections, including tuberculosis. We hypothesized that IRIS is associated with increased glycolysis and that 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) could help identify high-risk subjects...
September 11, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Fiona V Cresswell, Kenneth Ssebambulidde, Daniel Grint, Lindsey Te Brake, Abdul Musabire, Rachel R Atherton, Lillian Tugume, Conrad Muzoora, Robert Lukande, Mohammed Lamorde, Rob Aarnoutse, David Meya, David R Boulware, Alison M Elliott
Background : Tuberculous meningitis (TBM) has 44% (95%CI 35-52%) in-hospital mortality with standard therapy in Uganda. Rifampicin, the cornerstone of TB therapy, has 70% oral bioavailability and ~10-20% cerebrospinal fluid (CSF) penetration.  With current WHO-recommended TB treatment containing 8-12mg/kg rifampicin, CSF rifampicin exposures frequently fall below the minimal inhibitory concentration for M. tuberculosis . Two Indonesian phase II studies, the first investigating intravenous rifampicin 600mg and the second oral rifampicin ~30mg/kg, found the interventions were safe and resulted in significantly increased CSF rifampicin exposures and a reduction in 6-month mortality in the investigational arms...
2018: Wellcome Open Research
Shomron Ben-Horin, Gert Van Assche, Yehuda Chowers, Ella Fudim, Bella Ungar, Orit Picard, Miri Yavzori, Uri Kopylov, Mao Ren, Min-Hu Chen, Yael Peled-Potashnik, Itai Gueta, Rami Eliakim, Ronen Loebstein, Noa Markovits
Introduction: Thiopurine analogues discontinuation is common prior to live vaccines, during infection or when de-escalating therapy. Data regarding clearance of active metabolites and immune re-constitution is scant. Objectives: To determine drug elimination and immune re-constitution following thiopurine cessation. Methods: 6-thioguanine nucleotides (6-TGN) elimination kinetics were determined in 9 inflammatory bowel disease (IBD) patients discontinuing thiopurines...
August 27, 2018: Journal of Crohn's & Colitis
Zoe F Weiss, Josiah Rich, Edward J Wing
The etiology of posterior reversible encephalopathy (PRES) is typically multifactorial. Patients with HIV are at risk for the development of this syndrome. We review 17 published cases of HIV and PRES and describe the second reported case of PRES in the setting of HIV and immune reconstitution syndrome (IRIS). IRIS has not yet been described as a risk factor for PRES.
August 2018: Oxford Medical Case Reports
Moiz Topiwala, Nachiket Dubale, Mahender K Medisetty, Sunil Gaikwad, Divya Patel, Sanjay Pujari
We present the first case report of cytomegalovirus (CMV) cholangiopathy as possible immune reconstitution inflammatory syndrome (IRIS) in a human immunodeficiency virus (HIV)-infected individual, within two months of starting effective HAART. The patient presented with abdominal pain, nausea, vomiting, decreased appetite, and jaundice. The patient was diagnosed on ERCP as AIDS cholangiopathy, and biopsy of the ampulla showed acute inflammation with CMV inclusion bodies. The patient underwent sphincterotomy with CBD stenting and HAART continued without use of ganciclovir or valganciclovir...
2018: Case Reports in Infectious Diseases
P M Garrido, J Borges-Costa
The abrupt development of multiple melanocytic nevi has been described in association with many conditions, including human immunodeficiency virus infection. We report three cases of eruptive nevi in men with human immunodeficiency virus type 1 infection. One patient developed this phenomenon during the stage of acquired immunodeficiency syndrome. The other two patients had human immunodeficiency virus infection recently diagnosed and presented to our clinic reporting the development of multiple melanocytic nevi after starting highly active antiretroviral treatment, with improvement of their immunity...
June 15, 2018: Dermatology Online Journal
Charlotte Schutz, Angharad G Davis, Bianca Sossen, Rachel P-J Lai, Mpiko Ntsekhe, Yolande Xr Harley, Robert J Wilkinson
Inflammation, or the prolonged resolution of inflammation, contributes to death from tuberculosis. Interest in inflammatory mechanisms and the prospect of beneficial immune modulation as an adjunct to antibacterial therapy has revived and the concept of host directed therapies has been advanced. Such renewed attention has however, overlooked the experience of such therapy with corticosteroids. Areas covered: The authors conducted literature searches and evaluated randomized clinical trials, systematic reviews and current guidelines and summarize these findings...
October 2018: Expert Review of Respiratory Medicine
Ethel D Weld, Kelly E Dooley
Children and pregnant and postpartum women suffer an undue burden of HIV-associated tuberculosis (TB), but data are lacking on key aspects of their complex management. Often excluded from clinical trials, they are left with limited options for HIV-TB co-treatment. This review will focus on pharmacologic aspects of the treatment of HIV-TB coinfection in the special populations of children and pregnant and postpartum women. Pharmacogenomic considerations, rational dosing, Drug-Drug Interactions (DDIs), safety, Immune Reconstitution Inflammatory Syndrome (IRIS), and ethical and policy aspects of the inclusion of special populations in research will be surveyed...
August 23, 2018: Clinical Pharmacology and Therapeutics
Vincenzina Lo Re, Ioannis Petridis, Saša Živković, Gaetano Burgio, Alessandra Mularoni, Mariapina Milazzo, Gianvincenzo Sparacia, Riccardo Volpes, Angelo Luca, Salvatore Gruttadauria
Guillain-Barrè Syndrome, as part of the spectrum of dysimmune neuropathies, is unexpected to occur in immunocompromised hosts. We describe a clinical case of Guillain-Barrè syndrome, occurred a few weeks after a liver transplant, and we postulate that our case would satisfy all requirements to explain this peripheral nervous system complication as a clinical manifestation of an Immune reconstitution inflammatory syndrome. In this setting of liver transplantation, complicated by potentially multiple infective triggers, reduction of immunosuppression and reversal of pathogen-induced immunosuppression, through antimicrobial therapy, may have led to pro-inflammatory response...
October 2018: Clinical Neurology and Neurosurgery
Naomi F Walker, Cari Stek, Sean Wasserman, Robert J Wilkinson, Graeme Meintjes
PURPOSE OF REVIEW: Antiretroviral therapy (ART) is an essential, life-saving intervention for HIV infection. However, ART initiation is frequently complicated by the tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in TB endemic settings. Here, we summarize the current understanding highlighting the recent evidence. RECENT FINDINGS: The incidence of paradoxical TB-IRIS is estimated at 18% (95% CI 16-21%), higher than previously reported and may be over 50% in high-risk groups...
November 2018: Current Opinion in HIV and AIDS
Abdalsamih M Taeb, Joshua M Sill, Catherine J Derber, Michael H Hooper
Although Pneumocystis jiroveci pneumonia (PCP) is a frequent manifestation of acquired immune deficiency syndrome (AIDS), the granulomatous form is uncommon. Here, we present an unusual case of granulomatous PCP consequent to immune reconstitution inflammatory syndrome (IRIS) after highly active antiretroviral therapy. A 36-year-old woman with human immunodeficiency virus (HIV) presented with cough and dyspnea that were attributed to typical PCP associated with AIDS. She was successfully treated with antibiotic, steroid, and antiretroviral therapies...
August 16, 2018: International Journal of STD & AIDS
Trygve Holmøy, Øivind Torkildsen, Svetozar Zarnovicky
During treatment with fingolimod, B cells are redistributed from blood to secondary lymphoid organs, where they are protected from the effect of anti-CD20 and other cell-depleting therapies. We describe a multiple sclerosis patient who had almost complete depletion of B cells in blood during and shortly after treatment with fingolimod. He developed severe disease activity resembling immune reconstitution syndrome after switching from fingolimod to rituximab, with first dose being six weeks after fingolimod cessation...
2018: Case Reports in Neurological Medicine
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