BackgroundThe incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis (PTB) in India have not been studied prospectively.MethodsHIV+ patients with culture confirmed PTB started on anti-tuberculosis therapy (ATT) were followed prospectively after anti-retroviral therapy (ART) initiation. Established criteria for IRIS diagnosis were used including decline in plasma HIV RNA at IRIS event. Pre-ART plasma levels of interleukin (IL)-6 and C-reactive protein (CRP) were measured. Univariate and multivariate logistic regression models were used to evaluate associations between baseline variables and IRIS.ResultsOf 57 patients enrolled, 48 had complete follow up data. Median ATT-ART interval was 28 days (interquartile range, IQR 14–47). IRIS events occurred in 26 patients (54.2%) at a median of 11 days (IQR: 7–16) after ART initiation. Corticosteroids were required for treatment of most IRIS events that resolved within a median of 13 days (IQR: 9–23). Two patients died due to CNS TB-IRIS. Lower CD4+ T-cell counts, higher plasma HIV RNA levels, lower CD4/CD8 ratio, lower hemoglobin, shorter ATT to ART interval, extra-pulmonary or miliary TB and higher plasma IL-6 and CRP levels at baseline were associated with paradoxical TB-IRIS in the univariate analysis. Shorter ATT to ART interval, lower hemoglobin and higher IL-6 and CRP levels remained significant in the multivariate analysis.ConclusionParadoxical TB–IRIS frequently complicates HIV-TB therapy in India. IL-6 and CRP may assist in predicting IRIS events and serve as potential targets for immune interventions.

HIV-infected patients with tuberculosis treated with a thrice-weekly antituberculosis regimen are at a higher risk of ARR, compared with HIV-uninfected patients, in the presence of baseline isoniazid resistance. HAART reduces but does not eliminate the risk of ARR.

The influence of tuberculosis (TB)-immune reconstitution inflammatory syndrome (IRIS) on TB treatment outcomes and its risk factors were investigated among people with human immunodeficiency virus (HIV) and co-infected with TB. Methods: Newly diagnosed, culture-confirmed, pulmonary TB patients with HIV and enrolled in a clinical trial (NCT00933790) were retrospectively analysed for IRIS occurrence. Risk factors and TB outcomes (up to 18 months after initiation of anti-TB treatment [ATT]) were compared between people who experienced IRIS (IRIS group) and those who did not (non-IRIS group). Results: TB-IRIS occurred in 82 of 292 (28%) participants. Significant baseline risk factors predisposing to TB-IRIS occurrence in univariate analysis were: lower CD4 + T-cell count, CD4/CD8 ratio, haemoglobin levels, presence of extra-pulmonary TB focus, and higher HIV viral load; the last two retained significance in the multivariate analysis. After 2 months of ATT commencement, sputum smear conversion was documented in 45 of 80 (56.2%) vs. 124 of 194 (63.9%) (p = 0.23), culture conversion was in 75 of 80 (93.7%) vs. 178 of 194 (91.7%) (p = 0.57) and the median decline in viral load (log 10 copies/mm 3 ) was 2.7 in the IRIS vs. 1.1 in the non-IRIS groups (p < 0.0001), respectively. An unfavourable response to TB therapy was detected in 17 of 82 (20.7%) and 28 of 210 (13.3%) in the IRIS and non-IRIS groups, respectively (p = 0.14).

Background: Malaria is a major health problem with increased morbidity and mortality. Plasmodium falciparum and Plasmodium vivax are endemic infections in India and constitutes about 77% of the total malaria cases in Southeast Asia, commonly associated with hematological abnormalities. Hematological abnormalities that are observed in patients with malaria includes anemia and thrombocytopenia. Thrombocytopenia frequently complicates malarial infections and is usually noted in Plasmodium falciparum. In the present study we have tried to evaluate prognostic implications of altered platelet indices and factors associated with outcome of severe and complicated P. vivax malaria.Methods: This is cross sectional descriptive study of 60 patients with malaria caused by P. vivax who presented to Mahatma Gandhi medical college and research institute between june 2014 to April 2016.The smears positive for malaria exclusively caused by P.vivax infection were included in this study. Malaria was diagnosed by microscopic examination with both leishmain stained thin and giemsa stained thick smears. All blood cell counts were determined using automated equipment (ABX Pentra ES 60; Horiba) which provides MPV, PDW and PCT. Result:Out of 60 patients in the present study 56.7% were males and 43.3% were females, age of the patient ranges from 17-48 years with mean (SD) age of distribution were 32.10 (9.52).Complete blood count evaluation of all patients showed mean hemoglobin level of 9 g/dL. Mean hematocrit level of 26.68% (4.2%) and mean leukocyte count of 5866 (1170) cells/mm3. The mean platelet count was 95,247cells/ mm3. The MPV was 9.6 (0.96) µm, Mean PDW was 13.75% (0.89%) and mean PCT was 0.180% (0.033%) Conclusion: Our study concludes that history of fever associated with chills and rigor are sensitive indicator of malaria but lacks specificity. Platelet indices were altered during severe symptomatic malarial infection such as elevation of MPV and PDW with decreased PCT are the known potential risk factors associated with warning signs of acute malaria caused by plasmodium vivax. Even though these hematological parameters are useful predictors of acute malarial infection, identification of parasites and grading of parasitemia in peripheral smear were always gold standard for early treatment.

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