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Immune reconstitution syndrome

Matthew P O'Brien, Timothy J Ford, Bart J Currie, Joshua R Francis
BACKGROUND: Paediatric Cryptococcus gattii disease is rare, with only two previous cases recorded in the Northern Territory (NT) over the last 54 years. Immune reconstitution inflammatory syndrome (IRIS) is a recognised complication of C. gattii infection, even in the absence of an identified immunodeficiency syndrome; however, limited paediatric data exist. We present a series of three paediatric patients treated for C. gattii infection in the NT during 2016/2017. CASE DISCUSSIONS: All three cases were males aged 8-13 years at the time of presentation...
December 8, 2018: Journal of Paediatrics and Child Health
Ramya Vangipuram, Stephen K Tyring
Malignancies were one of the earliest recognized manifestations that led to the description of the acquired immune deficiency syndrome (AIDS). The majority of cancers in AIDS patients are associated with coinfection with oncogenic viruses, such as Epstein-Barr virus, human herpesvirus 8, and human papillomavirus, with resulting malignancies occurring secondary to diminished immune surveillance against viruses and virus-infected tumor cells. Over 50% of AIDS lymphomas are associated with Epstein-Barr virus (EBV) and/or HHV8 infection...
2019: Cancer Treatment and Research
Kristen Overton, Vidthyia Mennon, Nomvuyo Mothobi, Blake Neild, Elena Martinez, Jeffrey Masters, Peter Grant, Zakir Akhunji, Wei-Yuen Su, Adrienne Torda, Claudia M Whyte, Andrew Lloyd, Chris Weatherall, Ann Hofmeyr, Hong Foo, Kim Brookes, Debbie Marriott, Vitali Sintchenko, Kate Clezy, Pam Konecny, Jeffrey J Post
There is a global outbreak of infections due to Mycobacterium chimaera associated with cardiac surgery. The most serious infections involve prosthetic material implantation, and all have followed surgical procedures involving cardiopulmonary bypass. We describe a cluster of four cases following cardiac surgery at a tertiary referral centre in Sydney, Australia. We report novel clinical findings, including haemolysis and kidney rupture possibly related to immune reconstitution inflammatory syndrome. The positive effect of corticosteroids on haemodynamic function in two cases and the failure of currently recommended antimicrobial therapy to sterilise prosthetic valve material in the absence of surgery despite months of treatment are also critically examined...
December 2018: Internal Medicine Journal
Cissy Kityo, Alexander J Szubert, Abraham Siika, Robert Heyderman, Mutsa Bwakura-Dangarembizi, Abbas Lugemwa, Shalton Mwaringa, Anna Griffiths, Immaculate Nkanya, Sheila Kabahenda, Simon Wachira, Godfrey Musoro, Chatu Rajapakse, Timothy Etyang, James Abach, Moira J Spyer, Priscilla Wavamunno, Linda Nyondo-Mipando, Ennie Chidziva, Kusum Nathoo, Nigel Klein, James Hakim, Diana M Gibb, A Sarah Walker, Sarah L Pett
BACKGROUND: In sub-Saharan Africa, individuals infected with HIV who are severely immunocompromised have high mortality (about 10%) shortly after starting antiretroviral therapy (ART). This group also has the greatest risk of morbidity and mortality associated with immune reconstitution inflammatory syndrome (IRIS), a paradoxical response to successful ART. Integrase inhibitors lead to significantly more rapid declines in HIV viral load (VL) than all other ART classes. We hypothesised that intensifying standard triple-drug ART with the integrase inhibitor, raltegravir, would reduce HIV VL faster and hence reduce early mortality, although this strategy could also risk more IRIS events...
December 2018: PLoS Medicine
Kartik Natrajan, Mahenderkumar Medisetty, Raviraj Gawali, Ajit Tambolkar, Divya Patel, Vinay Thorat, Nachiket Dubale, Vrushali Khirid, Chinmay Saraf, Ameet Dravid
Parasitic infections such as Strongyloides stercoralis and HIV have been reported to coexist, particularly in resource-limited settings such as India. In an immunocompromised host, S. stercoralis can progress to strongyloidiasis hyperinfection syndrome (SHS). However, SHS is not common in patients with advanced HIV disease. Immune reconstitution inflammatory syndrome (IRIS) developing after initiation of antiretroviral therapy (ART) can target multiple pathogens including S . stercoralis . The authors present here a 46-year-old HIV-infected female who was recently diagnosed with HIV-1 infection, started ART, and developed SHS...
2018: Case Reports in Infectious Diseases
Christoph Boesecke, Jürgen K Rockstroh, Jan Thoden
Guidelines from 3 clinical societies and peer-reviewed publications have been reviewed for recent changes in the management of opportunistic infections. Trimethoprim and sulfamethoxazol administered intravenously is an option to treat cerebral toxoplasmosis if oral therapy is not feasible. CD4 T cell cut-off for starting prophylaxis with trimethoprim and sulfamethoxazole is now 200/µl. For prophylaxis and treatment of Pneumocystis pneumonia trimethoprim and sulfamethoxazole still are recommended. Liposomal amphotericin B + fluconazole is a new treatment option for cryptococcosis...
December 2018: Deutsche Medizinische Wochenschrift
Andy Sing Ong Tang, Yeon Chiat Teh, Chin Yung Chea, Siaw Tze Yeo, Hock Hin Chua
We present a case of disseminated Kaposi's sarcoma with both cutaneous and extracutaneous involvement in an HIV-infected patient with a relatively high CD4 count of 369 cell/mm3 . He developed chronic diarrhea, constitutional symptoms, worsening bilateral pleural effusion with respiratory distress, and progression of skin lesions distributed over his chest and extremities. The temporal relationship between rapid clinical progression and initiation of HAART suggested the possibility of Kaposi's sarcoma-associated immune reconstitution inflammatory syndrome, which eventually resulted in the death of this patient...
December 2018: Oxford Medical Case Reports
David S Lawrence, Nabila Youssouf, Síle L F Molloy, Alexandre Alanio, Melanie Alufandika, David R Boulware, Timothée Boyer-Chammard, Tao Chen, Francoise Dromer, Admire Hlupeni, William Hope, Mina C Hosseinipour, Cecilia Kanyama, Oliver Lortholary, Angela Loyse, David B Meya, Mosepele Mosepele, Conrad Muzoora, Henry C Mwandumba, Chiratidzo E Ndhlovu, Louis Niessen, Charlotte Schutz, Katharine E Stott, Duolao Wang, David G Lalloo, Graeme Meintjes, Shabbar Jaffar, Thomas S Harrison, Joseph N Jarvis
BACKGROUND: Cryptococcal meningitis (CM) is a major cause of mortality in HIV programmes in Africa despite increasing access to antiretroviral therapy (ART). Mortality is driven in part by limited availability of amphotericin-based treatment, drug-induced toxicities of amphotericin B deoxycholate and prolonged hospital admissions. A single, high-dose of liposomal amphotericin (L-AmB, Ambisome) on a fluconazole backbone has been reported as non-inferior to 14 days of standard dose L-AmB in reducing fungal burden...
November 23, 2018: Trials
Jyoti Rawre, Mamta Rai, Divya Namdeo, Rojaleen Das, Neena Khanna, Lalit Dar, Benu Dhawan
We report a case of mucocutaneous Herpes Simplex Virus (HSV)-2 and Cytomegalovirus (CMV) infection in a 39-year-old female with acquired immunodeficiency syndrome, who presented with a perigenital ulcer. The patient was receiving antiretroviral treatment (ART) for 3 months before presentation. Scraping from the perigenital ulcer was positive for HSV-2 and Treponema pallidum using polymerase chain reactions (PCR). The extent and duration of the lesions led us to consider the possibility of coinfection with CMV...
July 2018: Indian Journal of Medical Microbiology
Graeme Meintjes, Cari Stek, Lisette Blumenthal, Friedrich Thienemann, Charlotte Schutz, Jozefien Buyze, Raffaella Ravinetto, Harry van Loen, Amy Nair, Amanda Jackson, Robert Colebunders, Gary Maartens, Robert J Wilkinson, Lutgarde Lynen
BACKGROUND: Early initiation of antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected patients who have tuberculosis reduces mortality among patients with low CD4 counts, but it increases the risk of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS). METHODS: We conducted this randomized, double-blind, placebo-controlled trial to assess whether prophylactic prednisone can safely reduce the incidence of paradoxical tuberculosis-associated IRIS in patients at high risk for the syndrome...
November 15, 2018: New England Journal of Medicine
Sagar S Patel, Lisa A Rybicki, Donna Corrigan, Carol Dumont, Brian Bolwell, Robert Dean, Priscilla Figueroa, Rabi Hanna, Hien Liu, Aaron T Gerds, Brian Hill, Deepa Jagadeesh, Matt Kalaycio, Brad Pohlman, Kristin Ricci, Ronald Sobecks, Wen Lu, Betty K Hamilton, Navneet S Majhail
Donor-derived T-cells mediate graft-versus-leukemia effect, immune reconstitution, and graft-versus-host-disease (GvHD) after allogeneic hematopoietic cell transplantation (HCT). We examined the association of donor cell subsets with outcomes in recipients of myeloablative allogeneic HCT using bone marrow (BM, N = 359) grafts from 2002 to 2014 with related or unrelated donors. Analysis considered pre-infusion graft total nucleated cell (TNC), CD34+ CD3+, CD4+, CD8+ doses. Most patients received busulfan-cyclophosphamide or etoposide-total body irradiation conditioning for acute leukemia or myelodysplastic syndrome...
October 30, 2018: Bone Marrow Transplantation
Antonio T Hernandez Conte, David Ng, Danny Ramzy, Deanna Dilibero, Troy M LaBounty, Cyril Gaultier, Elizabeth C Behringer
The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been generally beneficial. However, because of various concerns, ECMO has rarely been used in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. We report our successful use of venovenous ECMO in a 29-year-old man who presented with severe respiratory distress secondary to Pneumocystis jirovecii pneumonia associated with undiagnosed infection with the human immunodeficiency virus and acquired immune deficiency syndrome...
August 2018: Texas Heart Institute Journal
A Balasko, Y Keynan
OBJECTIVES: The aim of this work was to review current treatment options and propose alternatives for immune reconstitution inflammatory syndrome (IRIS) in HIV-infected individuals with cryptococcal meningitis (CM) (termed 'HIV-CM IRIS'). As a consequence of the immunocompromised state of these individuals, the initial immune response to CM is predominantly type 2 T helper (Th2) /Th17 rather than Th1, leading to inefficient fungal clearance at the time of antiretroviral initiation, and a subsequent overexaggeration of the Th1 response and life-threatening IRIS development...
October 25, 2018: HIV Medicine
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
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