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Immune reconstitution syndrome

Jaime S Rosa Duque, Kelvin K W To, Alan K S Chiang, Godfrey C F Chan, Rosana W S Poon, Kwok-Yung Yuen, Shau-Yin Ha, Daniel K L Cheuk
We report the first case of microabscesses detected by polymerase chain reaction (PCR) amplification of nucleic acid from ultrasound-guided aspirated fluid in a three-year old boy with acute lymphoblastic leukemia and febrile neutropenia during induction chemotherapy. Fever persisted despite effective antifungal treatment. The addition of corticosteroid therapy successfully controlled the suspected immune reconstitution inflammatory syndrome (IRIS). This case highlights the utility of PCR and adjunctive corticosteroid in the approach of Candida tropicalis renal microabscesses in leukemic patients undergoing chemotherapy...
February 14, 2019: International Journal of Infectious Diseases: IJID
Gloria Dalla Costa, Vittorio Martinelli, Lucia Moiola, Francesca Sangalli, Bruno Colombo, Annamaria Finardi, Paola Cinque, Eva-Maria Kolb, Aiden Haghikia, Ralf Gold, Roberto Furlan, Giancarlo Comi
This study analyzed serum neurofilament light chains (NfL) in 2 European cohorts of 312 MS patients to investigate whether NfL are biomarkers of PML during natalizumab treatment. The cohort comprised 25 PML, 136 natalizumab-treated, and 151 untreated MS patients. Patients subsequently developing PML had similar NfL to other natalizumab-treated MS patients. At PML onset, NfL were 10-fold higher than in the pre-PML condition and in natalizumab-treated or untreated MS patients, and NfL continued to increase until onset of immune reconstitution inflammatory syndrome...
February 13, 2019: Annals of Neurology
Mitra Shourian, Salman T Qureshi
Cryptococcus neoformans is a ubiquitous environmental yeast and a leading cause of invasive fungal infection in humans. The most recent estimate of global disease burden includes over 200,000 cases of cryptococcal meningitis each year. Cryptococcus neoformans expresses several virulence factors that may have originally evolved to protect against environmental threats, and human infection may be an unintended consequence of these acquired defenses. Traditionally, C. neoformans has been viewed as a purely opportunistic pathogen that targets severely immune compromised hosts; however, during the past decade the spectrum of susceptible individuals has grown considerably...
2019: Frontiers in Immunology
Carolina Arana Stanis Schmaltz, Fernanda de Oliveira Demitto, Flavia Marinho Sant'Anna, Valeria Cavalcanti Rolla
BACKGROUND: Rifamycins are a group of antibiotics mainly used in the treatment of tuberculosis (TB), however they interact with antiretroviral therapy (ART). Rifabutin allows more regimens options for concomitant imunodeficiency virus (HIV) treatment compared to rifampicin. OBJECTIVE: Compare the outcomes of TB-HIV co-infected patients who used rifampicin or rifabutin. METHODS: We analysed data from a prospective cohort study at National Institute of Infectious Diseases Evandro Chagas, Rio de Janeiro (RJ), Brazil...
February 11, 2019: Memórias do Instituto Oswaldo Cruz
Alexandra F Freeman, Nada Yazigi, Nirali N Shah, David E Kleiner, Mark Parta, Prescott Atkinson, Theo Heller, Steven M Holland, Stuart S Kaufman, Khalid M Khan, Dennis D Hickstein
BACKGROUND: An 11-year old girl with DOCK8 deficiency was proposed for potentially curative hematopoietic stem cell transplantation (HSCT), the donor being her haploidentical mother. However, end-stage liver disease, caused by chronic Cryptosporidium infection required liver transplantation before HSCT. METHODS: Consequently, a staged approach of a sequential liver transplant followed by a HSCT was planned, with her mother as the donor for both liver and HSCT. RESULTS: The patient successfully underwent a left lobe orthotopic liver transplant, however, she developed a biliary leak delaying the HSCT...
January 30, 2019: Transplantation
Eric W Djimeu, Anna C Heard
Co-diagnosis of HIV and tuberculosis presents a treatment dilemma. Starting both treatments at the same time can cause a flood of immune response called immune reconstitution inflammatory syndrome (IRIS) which can be lethal. But, how long to delay HIV treatment is less understood. In 2011, based on the conclusions of three separate studies, WHO recommended starting HIV treatment earlier for those with later HIV disease progression. This paper conducts a replication study of one of the three studies, by Havlir and colleagues...
2019: PloS One
Nobuyoshi Kusano, Naoki Sakata, Keisuke Sugimoto, Tomoki Miyazawa, Satoshi Ueda, Munehiro Okano, Ken-Ichi Imadome, Akihiro Hoshino, Hirokazu Kanegane, Masatomo Kimura, Takao Sato, Mitsuru Okada, Tsukasa Takemura
X-linked lymphoproliferative syndrome type 1 (XLP1) is a rare congenital immunodeficiency disease. We report the case of an 18-year-old male who developed hemophagocytic lymphohistiocytosis (HLH) with neurological complications after primary Epstein-Barr virus (EBV) infection and subsequently developed EBV-related central nervous system lymphoma (CNSL). Given the vulnerability to EBV, he was finally diagnosed with XLP1 and treated with whole-brain irradiation along with chemotherapy and subsequent allogeneic hematopoietic stem cell transplantation from a SH2D1A wild-type sibling donor...
January 22, 2019: Journal of Pediatric Hematology/oncology
Abdulrahman M AlTahan, Thomas Berger, Ibrahim A AlOrainy, Husam AlTahan
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is a serious opportunistic infectious disease with high morbidity and mortality. Its incidence in multiple sclerosis (MS) patients has risen since the introduction of disease modifying drugs. In the absence of a specific treatment, the outcome depends heavily on early diagnosis, which illustrates the importance of the role of characteristic brain magnetic resonance imaging (MRI). However, when relying mainly on MRI, the diagnosis of cases with atypical radiological changes may be missed or delayed...
January 24, 2019: American Journal of Case Reports
Deep Dutta, Meha Sharma, Atul Anand, Umesh Chandra Garga, Rahul Bansal, Neera Sharma
Background & objectives: Dyslipidaemia is a major contributor to cardiovascular morbidity, which is increased in HIV. Data on dyslipidaemia in Indians with HIV are scant. This study was undertaken to determine the predictors of dyslipidaemia and lipoatrophy in Indians with HIV infection and their relation with body composition parameters. Methods: A total of 382 consecutive patients with HIV infection were screened, of whom 257 clinically stable patients, without any acute comorbidity, having at least one year follow up underwent biochemical and DEXA analysis...
October 2018: Indian Journal of Medical Research
Theodore Wright, Basak Coruh, David Fredricks, Nina Kim
Endemic fungal infections are a significant problem for patients on TNF-alpha inhibitors. Immune reconstitution inflammatory syndrome, IRIS, can present in patients with waning TNF-alpha inhibition and an endemic fungal infection. There may be a potential role that TNF-alpha inhibitors can play in mitigating IRIS related to disseminated endemic fungal infections.
March 2019: Medical Mycology Case Reports
Genovefa A Papanicolaou, Celalettin Ustun, Jo-Anne H Young, Min Chen, Soyoung Kim, Kwang Woo Ahn, Krishna Komanduri, Caroline Lindemans, Jeffery J Auletta, Marcie L Riches
Background: We examined the impact of Enterococcus (VRE) bloodstream infection (BSI) on outcomes of allogeneic hematopoietic cell transplantation (HCT) utilizing the Center for International Blood and Marrow Transplant Research (CIBMTR) database. Methods: Adult and pediatric patients (n=7,128), who underwent first HCT for acute leukemia or myelodysplastic syndrome from 2008 through 2012, were analyzed as 3 groups-VRE-BSI, non-VRE-BSI, without BSI-according to BSI status at 100 days (D100) after allogeneic HCT...
January 14, 2019: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Ngomu Akeem Akilimali, Daniel M Muema, Charles Specht, Christina C Chang, Mahomed-Yunus S Moosa, Stuart M Levitz, Sharon R Lewin, Martyn A French, Thumbi Ndung'u
BACKGROUND: Systemic levels of interleukin (IL)-7 at antiretroviral therapy (ART) initiation have previously been shown to be predictive of HIV-linked paradoxical cryptococcosis-associated immune reconstitution inflammatory syndrome (C-IRIS). We therefore explored IL-7/IL-7 receptor (IL-7/IL-7R) signaling pathway dysfunction, with related alterations in immune function, as a mechanism underlying C-IRIS. METHOD: HIV-infected patients with cryptococcal meningitis (CM) who experienced C-IRIS (n=27) were compared to CD4+ T-cell count-matched counterparts without C-IRIS (n=27), following antifungal therapy and pre-ART initiation...
January 8, 2019: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Tommaso Lupia, Cecilia Costa, Nicola Forni, Andrea Calcagno
No abstract text is available yet for this article.
January 9, 2019: Giornale Italiano di Dermatologia e Venereologia: Organo Ufficiale, Società Italiana di Dermatologia e Sifilografia
Thorsten Bartsch, Torge Rempe, Frank Leypoldt, Christian Riedel, Olav Jansen, Daniela Berg, Günther Deuschl
JC-virus (JCV) infection of the central nervous system (CNS) causes progressive multifocal leukoencephalopathy (PML) in patients with systemic immunosuppression. With the increased application of modern immunotherapy and biologics in various immune-mediated disorders, the PML risk spectrum has changed. Thus, new tools and strategies for risk assessment and stratification in drug-associated PML such as the JCV antibody indices have been introduced. Imaging studies have highlighted atypical presentations of cerebral JCV disease like granule cell neuronopathy...
January 10, 2019: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Emma Davies, Adam Shipp, Rob Hawkes, Robert F Wynn
Saccharomyces cerevisiae is an emerging pathogen within the immunocompromised. We present a 4-year-old boy with acute lymphoblastic leukemia presenting with polymerase chain reaction-confirmed hepatosplenic S. cerevisiae infection and significant immune reconstitution symptoms. We explore the challenges of monitoring treatment efficacy using C-Reactive protein, β-D-glucan, and imaging and the administration of chemotherapy alongside antifungals and steroids for control of immune reconstitution syndrome.
January 8, 2019: Journal of Pediatric Hematology/oncology
Stephanie J Kim, Michael J Peluso, Yongmei Wang, Daniel Bikle, Dolores Shoback, Sarah Kim
Hypercalcemia in HIV patients has been previously reported, but 1,25-(OH)2 vitamin D-mediated hypercalcemia, due to increased activity of extrarenal 1-alpha hydroxylase, is rarely described with HIV-related infections or malignancies. We describe a case of 1,25-(OH)2 vitamin D-mediated hypercalcemia in a patient presenting with progressive cognitive decline and weakness. Initial evaluation revealed a new diagnosis of HIV, for which he was started on antiretroviral therapy (ART). He was also noted to have mild asymptomatic hypocalcemia, likely from his acute illness and malnutrition, which was not further investigated at the time...
June 2019: Bone Reports
Aayush Gupta, Yugal Kishor Sharma, Manoj Ghogre, Shubhshree Misra, Shilpa Pawar
Restoration of specific immune responses by combined antiretroviral therapy (cART) in patients infected with human immunodeficiency virus (HIV) may paradoxically cause an inflammatory reaction known as immune reconstitution inflammatory syndrome (IRIS). We report the emergence of giant nodules of molluscum contagiosum (MC) on the face and thighs 2 months after initiation of cART in a 45-year-old male patient with acquired immune deficiency syndrome. To the best of our knowledge, our report describes the first case of MC probably unmasked during IRIS from India...
July 2018: Indian journal of sexually transmitted diseases and AIDS
Sonia Quintas, Pedro Sánchez, Manuel López, José Vivancos
The incidence of brain abscess is higher among immunosuppressed patients. We report a case of a brain abscess in the temporal lobe in a patient under treatment with adalimumab and methotrexate, who developed radiological worsening. Clinical remission was essential to suspect Immune Reconstitution Inflammatory Syndrome and to continue empirical antimicrobial therapy due to the low suspicion of worsening of the abscess itself.
January 2, 2019: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Sungmin Sohn, Hye Jin Shi, Sung Ho Wang, Sang Ki Lee, So Yeon Park, Jin Seo Lee, Joong Sik Eom
In acquired immunodeficiency syndrome (AIDS) patients, immune reconstitution inflammatory syndrome (IRIS) due to Mycobacterium avium complex (MAC) infection is one of the most difficult IRIS types to manage. We report an unusual case of MAC-associated IRIS. At first the patient was diagnosed human immunodeficiency virus (HIV) infection after he was admitted with pneumocystis pneumonia. After starting antiretroviral therapy he presented unmasked IRIS with MAC infection. Next, he was hospitalized with continuous loose stools and new-onset fever...
December 2018: Infection & Chemotherapy
Michael W Rowley, Amitkumar Patel, Wendi Zhou, Mark Wong, Anil B Seetharam
Immune reconstitution syndrome is a recognized complication with initiation of highly active antiretroviral therapy for acquired immune deficiency syndrome patients co-infected with hepatitis B. Hepatitis B flares are seen in 20%-25% of patients after initiation of highly active antiretroviral therapy, an estimated 1%-5% of whom develop clinical hepatitis. We present a case of highly active antiretroviral therapy initiation for HIV that led to a flare of HBV activity despite antiviral therapy directed towards both...
December 13, 2018: Annals of Hepatology
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