Multiphasic and multifocal cryptococcal immune reconstitution inflammatory syndrome in an HIV-infected patient: interplay of infection and immunity

Katchanov, Juri; Zimmermann, Ulrike; Branding, Gordian; Tintelnot, Kathrin; Müller, Markus; Arastéh, Keikawus; Stocker, Hartmut

doi:10.1016/j.ijid.2013.08.012

Cited by 5 publications

(8 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cryptococcal IRIS may manifest as relapsing aseptic meningitis, increased intracranial pressure, new focal neurologic signs, intracranial cryptococcomas, lymphadenopathy, and/or development of abscesses [11, 19, 52–54] which can present as multifocal or multiphasic disease [55*]. Mortality associated with cryptococcal IRIS ranges from 0 to 67% [19, 20, 50].…”

Section: Epidemiology Of Cryptococcal Meningitis Immune Reconstitutiomentioning

confidence: 99%

The immunopathogenesis of cryptococcal immune reconstitution inflammatory syndrome

Meya

Manabe

Boulware³

et al. 2016

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

Purpose of Review Cryptococcal meningitis (CM) causes significant mortality among HIV-infected patients, despite antifungal therapy and use of antiretroviral therapy (ART). In patients with CM, ART is often complicated by immune reconstitution inflammatory syndrome (IRIS), manifesting as unmasking of previously unrecognized subclinical infection (unmasking CM-IRIS) or paradoxical worsening of symptoms in the central nervous system after prior improvement with antifungal therapy (paradoxical CM-IRIS). We review our current understanding of the pathogenesis of this phenomenon, focusing on unifying innate and adaptive immune mechanisms leading to the development of this often fatal syndrome. Recent Findings We propose that HIV-associated CD4+ T cell depletion, chemokine-driven trafficking of monocytes into cerebrospinal fluid (CSF) in response to CM, and poor localized innate cytokine responses lead to inadequate cryptococcal killing and clearance of the fungus. Subsequent ART-associated recovery of T cell signaling and restored cytokine responses, characterized by Interferon-γ production, triggers an inflammatory response. The inflammatory response triggered by ART is dysregulated due to impaired homeostatic and regulatory mechanisms, culminating in the development of CM-IRIS. Summary Despite our incomplete understanding of the immunopathogenesis of CM-IRIS, emerging data exploring innate and adaptive immune responses could be exploited to predict, prevent and manage CM-IRIS and associated morbid consequences.

show abstract

Section: Epidemiology Of Cryptococcal Meningitis Immune Reconstitutiomentioning

confidence: 99%

The immunopathogenesis of cryptococcal immune reconstitution inflammatory syndrome

Meya

Manabe

Boulware³

et al. 2016

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…1 Antifungal therapy was enhanced with liposomal amphotericin B and 5-flucytosine in a patient with localized paradoxical pulmonary C-IRIS (Table 1). 7 We did not intensify the antifungal therapy in our patient as evidence of active cryptococcal infection was not found when pulmonary C-IRIS was diagnosed. Corticosteroids were shown to be very effective in this case.…”

Section: Discussionmentioning

confidence: 86%

“…This search strategy yielded a total of 36 studies, among which five were relevant studies. [7][8][9][10][11] Reviewing of bibliographies and citations of those five literatures yielded another additional three relevant literatures. [12][13][14] Seven candidate cases of paradoxical pulmonary C-IRIS were identified from those eight relevant literatures.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] Seven candidate cases of paradoxical pulmonary C-IRIS were identified from those eight relevant literatures. [7][8][9][10][11][12][13][14] We excluded two cases in which the diagnosis of paradoxical pulmonary C-IRIS was uncertain; 8,13 therefore five cases of paradoxical pulmonary C-IRIS were included in the final analysis. The characteristics of those patients in other studies as well as our patient are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary cryptococcal immune reconstitution syndrome in a person living with HIV: a case report

Liu

et al. 2020

Int J STD AIDS

View full text Add to dashboard Cite

Cryptococcal immune reconstitution inflammatory syndrome (C-IRIS) in human immunodeficiency virus (HIV)-1 infection manifests as a clinical worsening or new presentation of cryptococcal disease after initiating antiretroviral therapy (ART). C-IRIS involving the respiratory system has been scarcely reported. Here, we report a case of pulmonary C-IRIS in a person living with HIV after initiating ART, characterized by an exacerbation of a pulmonary nodule and new occurrence of pleural effusions, which responded well to corticosteroid treatment.

show abstract

“…On the other hand, paradoxical cryptococcal IRIS does not require a new course of induction and consolidation therapy, because the pathogens are no longer viable. Many clinicians end up giving standard antifungal therapy while waiting for negative cultures [ 6 ], which also occurred in our case. Adjunctive therapy with steroids can be considered in patients with severe paradoxical responses.…”

mentioning

confidence: 72%

Cryptococcal Lymphadenitis in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Zamora

Varadarajalu

2018

Diseases

View full text Add to dashboard Cite

Cryptococcosis is a fungal infection that is typically associated with acquired immunodeficiency syndrome (AIDS). The advent of highly active antiretroviral therapy has decreased the frequency of this infection, but has led to the emergence of atypical cases of immune reconstitution inflammatory syndrome (IRIS). Here, we describe the case of a 40-year-old man who was diagnosed with HIV infection and cryptococcal meningitis. He was successfully treated with antifungals and then started antiretroviral therapy. The patient returned to the hospital 15 months later complaining of fever, pain, and neck swelling. A computed tomography (CT) scan revealed a conglomerate of necrotic lymph nodes in the supraclavicular region. He underwent biopsy and histology showed granulomatous inflammation with fungal elements, consistent with Cryptococcus. He tested positive for serum cryptococcal antigen. The patient was treated with liposomal amphotericin and flucytosine. After induction therapy, he was re-started on fluconazole. The final fungal cultures were negative. We attributed our patient’s clinical presentation to “paradoxical” IRIS, which was associated with his previously treated cryptococcosis. Near resolution of the supraclavicular mass was noted at the 3-month follow-up.

show abstract

Multiphasic and multifocal cryptococcal immune reconstitution inflammatory syndrome in an HIV-infected patient: interplay of infection and immunity

Cited by 5 publications

References 5 publications

The immunopathogenesis of cryptococcal immune reconstitution inflammatory syndrome

The immunopathogenesis of cryptococcal immune reconstitution inflammatory syndrome

Pulmonary cryptococcal immune reconstitution syndrome in a person living with HIV: a case report

Cryptococcal Lymphadenitis in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Contact Info

Product

Resources

About