Immune reconstitution inflammatory syndrome associated with disseminated mycobacterial infection in patients with AIDS.
Restoration of the immune system after highly active antiretroviral therapy (HAART) resulting from a quantitative and qualitative process of cell immune activity recovery may evolve with adverse clinical phenomena, known as the immune reconstitution inflammatory syndrome (IRIS). It can occur in association with several opportunist infections, although most reported cases have been related to mycobacterial infection caused by Mycobacterium tuberculosis and Mycobacterium avium. We describe three clinical cases of mycobacterial infection with different presentation patterns of IRIS after HAART. In each of these patients, immune reconstitution led to clinical manifestation of a latent infection, or clinical worsening of preexisting lesions, or manifestation of new lesions in the central nervous system. Clinical aspects of IRIS are presented in the paper and clinical management options for this event are carefully discussed.
Tuon
Felipe Francisco
FF
Department of Infectious and Parasitic Diseases, School of Medicine, University of Sao Paulo, SP, Brazil. ffbt@pop.com.br
Mulatti
Grace Carvajal
GC
Pinto
Walkyria Pereira
WP
de Siqueira Franca
Francisco Oscar
FO
Gryschek
Ronaldo Cesar
RC
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000150:complications*; D015269:Mycobacterium avium Complex / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications*; D020306:Tuberculosis, Central Nervous System / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000382:microbiology