Prolonged Paradoxical Reaction of Tuberculosis in an HIV-Infected Patient after Initiation of Highly Active Antiretroviral Therapy

The risk factors for development of paradoxical response were studied in a cohort of 104 patients with culture-documented Mycobacterium tuberculosis infection. Paradoxical deterioration occurred in 16 (15.4%) patients (case group) during antituberculosis therapy, involving lungs and pleura (n=4), spine and paraspinal tissue (n=5), intracranium (n=3), peritoneum (n=2), bone and joint (n=1), and lymph node (n=1). The median time from commencement of treatment to paradoxical deterioration was 56 days (range, 20-109 days). Compared with 53 patients without clinical deterioration after antituberculosis therapy (control group), patients with paradoxical response were more likely to have extrapulmonary involvement (62.5% vs. 17.0%; P<0.05) at initial diagnosis, to have lower baseline lymphocyte counts (672+/-315 cells/microl vs. 1,328+/-467 cells/microl; P<0.001), and to exhibit a greater surge in lymphocyte counts (627+/-465 cells/microl vs. 225+/-216 cells/microl; P<0.05) during paradoxical response. Further studies on lymphocyte subsets and cytokine levels would be useful in understanding the exact immunological mechanisms involved in immunorestitution.

show abstract

Risk Factors for Development of Paradoxical Response During Antituberculosis Therapy in HIV-Negative Patients

Cheng

Yam

Woo

et al. 2003

European Journal of Clinical Microbiology & Infectious Dise

155

108

View full text Add to dashboard Cite

show abstract

Tuberculosis drug therapy in adults

Grzemska¹

2009

Tuberculosis

View full text Add to dashboard Cite

Immune reconstitution inflammatory syndrome associated with Mycobacterium tuberculosis infection: a systematic review

Leone

Nicastri

Giglio

et al. 2010

International Journal of Infectious Diseases

View full text Add to dashboard Cite

HIV and tuberculosis (TB) are leading global causes of mortality and morbidity. Highly active antiretroviral therapy (HAART) is often initiated in patients being treated for TB. The immune recovery associated with HAART results in dramatic clinical benefits, but this restoration of immunity may result in immunopathological reactions. The immune reconstitution inflammatory syndrome can result in fever, nodal enlargement, and worsening pulmonary infiltrates observed on a chest radiograph, with or without recurrent respiratory symptoms. Several other manifestations have also been described. As a consequence, the use of HAART might not be appropriate during the first weeks of anti-TB therapy in HIV-infected patients. In this review, we summarize the incidence, clinical presentations, and potential mechanisms of these conditions and we describe therapeutic methods.

show abstract

Prolonged Paradoxical Reaction of Tuberculosis in an HIV-Infected Patient after Initiation of Highly Active Antiretroviral Therapy

Cited by 5 publications

References 8 publications

Risk Factors for Development of Paradoxical Response During Antituberculosis Therapy in HIV-Negative Patients

Risk Factors for Development of Paradoxical Response During Antituberculosis Therapy in HIV-Negative Patients

Tuberculosis drug therapy in adults

Immune reconstitution inflammatory syndrome associated with Mycobacterium tuberculosis infection: a systematic review

Contact Info

Product

Resources

About