Recurrent Immune Reconstitution Inflammatory Syndrome of Tuberculous Brain Infection in People Living with HIV/AIDS

Raja, Kavitha; Chokkalingam, Chandrasekar; Krishnarajasekhar, O. R.; Ravichandran, N.; Sadagopan, Kumar; Ayyamperumal, M.

doi:10.1177/2325957413488170

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…Dynamic enhancement scans of the lesion exhibit minimal to no enhancement and reveal internal tiny vessels. This is distinct from the perifocal edema and ring-like enhancement of tuberculous encephalitis [11] . Vascular infarction which is regarded as a type of CMV-associated IRIS [12] , is a rare clinical and radiological presentation of patients with CNS CMV infection [13] .…”

Section: Discussionmentioning

confidence: 79%

The dynamic changes of recurrent Immune reconstitution inflammatory syndrome of an AIDS patient with cytomegalovirus encephalitis and pulmonary tuberculosis：a case report

Song

Jiang

Gan

et al. 2023

Preprint

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Background This study describes an AIDS patient with central nervous systems tuberculosis, and cytomegalovirus infection who experienced immune reconstitution inflammatory syndromes associated to cytomegalovirus encephalitis and pulmonary tuberculosis while receiving antiretroviral therapy. Case presentation A 59-year-old male with fever of unknown origin with dizziness, fatigue, loss of appetite, fear of cold, occasional babbling during fever, and paroxysmal cough as the main symptoms three days was referred to our hospital Cerebrospinal fluid examination showed a cytomegaloviral load of 3.4×103 copies/ml and a positive mycobacterium tuberculosis recombination test. Cerebrospinal fluid gene X-pert MTB/RIF test showed mycobacterium tuberculosis infection without rifampicin resistance. Anti-tuberculosis treatment and anti-cytomegalovirus therapy were administered, and clinical and laboratory abnormalities were improved. The patient's CD4+ T lymphocyte count was 70 cells/μl, and antiretroviral therapy was started 24 days after the start of anti-tuberculosis treatment. Clinical symptoms reappeared on day 33 after antiretroviral therapy treatment. Relapsing - immune reconstitution inflammatory syndrome was considered as the most likely diagnosis. After the addition of a small amount of dexamethasone to continue anti-tuberculosis and anti-cytomegalovirus therapy, the patient's symptoms disappeared and imaging was reduced in scope. There was no recurrence of clinical symptoms at 2 years of outpatient follow-up. Conclusion It is important to take aware of the emergence of multiple infections and the associated immune reconstitution inflammatory syndrome in AIDS. Once the immune reconstitution inflammatory syndrome manifests, a proper diagnosis and continual of treatment are imperative to the patient's recovery.

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Section: Discussionmentioning

confidence: 79%

The dynamic changes of recurrent Immune reconstitution inflammatory syndrome of an AIDS patient with cytomegalovirus encephalitis and pulmonary tuberculosis：a case report

Song

Jiang

Gan

et al. 2023

Preprint

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“…Thus, patients that are cured at the end of therapy can be infected with a new strain, and might be still at risk to develop severe and complicated diseases [9]. Likewise, recurrent opportunistic infections (OIs) of central nervous system (CNS) will be very difficult to manage with high morbidity and mortality in acute phase of the disease [10].…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of reoccurrence of opportunistic infection among adult HIV/AIDS patients attending ART clinic at public health facilities in Arba Minch town, southern Ethiopia: A retrospective cohort study

et al. 2021

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Background Human immunodeficiency virus (HIV) infected individuals are prone to opportunistic infections (OIs) due to HIV mediated immune suppression. When opportunistic infections occur in the form of relapse or reinfection, it is said to be reoccurrence. This study was aimed to assess Incidence and predictors of reoccurrence of opportunistic infections among adult people living with HIV (PLHIV) attending ART clinics in Arba Minch Town, Southern Ethiopia Methods This retrospective cohort study was conducted on 450 HIV/AIDS patients attending anti-retro viral therapy (ART) clinics in Arba Minch town, southern Ethiopia. Simple random sampling technique was used. Kaplan-Meier graph and log rank test were used for group wise comparison. Bivariate and multivariable Cox Proportional Hazard Regression model were used to identify independent predictors of reoccurrence of opportunistic infection. Result One hundred nineteen HIV/AIDS patient had reoccurrence of opportunistic infection. The incidence rate was 11.5 per 1000 person months. The mean time of reoccurrence was 56 months. One of the most reoccurred OIs was pulmonary tuberculosis (PTB). Predictors that were associated significantly were recent cell differentiation 4 (CD4) count, recent body mass index (BMI), recent functional status, and duration on anti-retroviral therapy (ART). Conclusion Though the incidence rate of OIs decreased from previous findings, attention should be given to HIV patients with low CD4 count, low BMI and for those bedridden patients.

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Post-tuberculosis treatment paradoxical reactions

Hermans,

Akkerman,

Meintjes

et al. 2024

Infection

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Paradoxical reactions (PR) to tuberculosis (TB) treatment are common during treatment, but have also been described after treatment. A presentation with recurrent signs or symptoms of TB after cure or completion of prior treatment needs to be differentiated between microbiological relapse and a paradoxical reaction. We searched all published literature on post-treatment PR, and present a synthesis of 30 studies, focusing on the epidemiology, diagnosis and management of this phenomenon. We report an additional case vignette. The majority of studies were of lymph node TB (LN-TB), followed by central nervous system TB (CNS-TB). A total of 112 confirmed and 42 possible post-treatment PR cases were reported. The incidence ranged between 3 and 14% in LN-TB and was more frequent than relapses, and between 0 and 2% in all TB. We found four reports of pulmonary or pleural TB post-treatment PR cases. The incidence did not differ by length of treatment, but was associated with younger age at initial diagnosis, and having had a PR (later) during treatment. Post-treatment PR developed mainly within the first 6 months after the end of TB treatment but has been reported many years later (longest report 10 years). The mainstays of diagnosis and management are negative mycobacterial cultures and anti-inflammatory treatment, respectively. Due to the favourable prognosis in LN-TB recurrent symptoms, a short period of observation is warranted to assess for spontaneous regression. In CNS-TB with recurrent symptoms, immediate investigation and anti-inflammatory treatment with the possibility of TB retreatment should be undertaken.

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Recurrent Immune Reconstitution Inflammatory Syndrome of Tuberculous Brain Infection in People Living with HIV/AIDS

Cited by 5 publications

References 5 publications

The dynamic changes of recurrent Immune reconstitution inflammatory syndrome of an AIDS patient with cytomegalovirus encephalitis and pulmonary tuberculosis：a case report

The dynamic changes of recurrent Immune reconstitution inflammatory syndrome of an AIDS patient with cytomegalovirus encephalitis and pulmonary tuberculosis：a case report

Incidence and predictors of reoccurrence of opportunistic infection among adult HIV/AIDS patients attending ART clinic at public health facilities in Arba Minch town, southern Ethiopia: A retrospective cohort study

Post-tuberculosis treatment paradoxical reactions

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