Abstract | BACKGROUND: METHODS: We prospectively assessed patients with suspected TB-IRIS from June 2005 through October 2007 at our hospital in Cape Town, South Africa. We defined paradoxical TB-IRIS and paradoxical neurologic TB-IRIS with use of consensus clinical case definitions. We collected data on tuberculosis diagnosis, ART, details of TB-IRIS diagnosis, other opportunistic infections, corticosteroid use, and outcome. RESULTS: We reviewed 279 patients with suspected TB-IRIS, 54 (19%) of whom had suspected neurologic TB-IRIS, and 225 (81%) of whom had suspected non-neurologic TB-IRIS. Paradoxical TB-IRIS was diagnosed in 190 patients; 23 (12%) of these 190 patients had neurologic TB-IRIS (95% confidence interval, 7%-17%). Eight had meningitis, 7 had tuberculoma, 5 had both tuberculoma and meningitis, and 3 had radiculomyelopathy. Twenty (87%) of the 23 patients with neurologic TB-IRIS required hospital admission (median duration, 12 days; interquartile range, 6-24 days), and 21 (91%) received corticosteroids (median duration, 58 days; interquartile range, 29-86 days). Outcomes 6 months after the initial assessment for neurologic deterioration were as follows: 16 (70%) of the patients were alive (10 of these patients had documented full physical and mental recovery), 3 (13%) were dead, and 4 (17%) were lost to follow-up. CONCLUSIONS: Paradoxical neurologic TB-IRIS accounts for 12% of paradoxical TB-IRIS cases. Neurologic TB-IRIS causes considerable short-term morbidity but has reasonable long-term outcomes. Further research is needed to devise optimal diagnostic and management strategies for patients with tuberculosis who experience neurologic deterioration after starting ART.
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Authors | Dominique J Pepper, Suzaan Marais, Gary Maartens, Kevin Rebe, Chelsea Morroni, Molebogeng X Rangaka, Tolu Oni, Robert J Wilkinson, Graeme Meintjes |
Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
(Clin Infect Dis)
Vol. 48
Issue 11
Pg. e96-107
(Jun 01 2009)
ISSN: 1537-6591 [Electronic] United States |
PMID | 19405867
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
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Chemical References |
- Adrenal Cortex Hormones
- Anti-HIV Agents
|
Topics |
- Adrenal Cortex Hormones
(therapeutic use)
- Adult
- Anti-HIV Agents
(adverse effects, therapeutic use)
- Antiretroviral Therapy, Highly Active
(adverse effects)
- Female
- HIV Infections
(drug therapy)
- Humans
- Immune Reconstitution Inflammatory Syndrome
(pathology, physiopathology)
- Male
- Prospective Studies
- South Africa
- Treatment Outcome
- Tuberculoma
(pathology, physiopathology)
- Tuberculosis, Central Nervous System
(pathology, physiopathology)
- Tuberculosis, Meningeal
(pathology, physiopathology)
- Young Adult
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