Distinct paradoxical inflammatory reaction followed by postantiretroviral therapy immune reconstitution syndrome in cryptococcal meningitis

Gaillet, Antoine; Câlin, Ruxandra; Imbert, Sébastien; Ollivier, Morgan; Fekkar, Arnaud; Pourcher, Valérie

doi:10.1097/qad.0000000000001994

Cited by 5 publications

(10 citation statements)

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“…uma complicação comum que se manifesta após o início da terapia antirretroviral (TARV) 3 . A SIRI criptococócica apresenta-se como uma reação imune pró-inflamatória exagerada e desregulada, que acompanha a redução da carga viral e o início da recuperação das células TCD4+ no sangue periférico.…”

Section: Aheah Of Printunclassified

Síndrome inflamatória da reconstituição imune associada à meningite criptococócica: fatores de risco e biomarcadores

Brienze

Andre

Liso

et al. 2021

ACS

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Introdução: Síndrome Inflamatória da Reconstituição Imune (SIRI) se apresenta como uma resposta imune exagerada que ocorre durante uma restauração imune desregulada em pacientes imunocomprometidos em estágio avançado da infecção pelo HIV quando iniciam tratamento com antirretrovirais. Qualquer patógeno oportunista pode provocar este tipo de desordem durante a restauração imune. Objetivo: Identificar os recentes avanços nos fatores de risco e nos biomarcadores moleculares de prognóstico e diagnóstico da Síndrome Inflamatória da Reconstituição Imune associada à meningite criptococócica para melhor compreender sua imunopatogênese. Método: Revisão de escopo conforme a proposta de Joana Briggs Institute. A busca foi realizada por dois pesquisadores independentes, nas bases de dados PubMed e do Google Acadêmico, por meio de descritores e/ou seus sinônimos. Resultados: A busca resultou em 240 artigos. Destes, 36 foram excluídos por serem repetidos; 1 utilizou modelos animais; 3 eram sobre pacientes soronegativos para o HIV; 8 não eram sobre Cryptococcus; 3 falavam sobre tuberculose e 1 sobre criptococose pulmonar. Foram destacados estudos que analisaram fatores de risco e biomarcadores, no sangue / plasma e líquido cefalorraquidiano, que podem esclarecer a imunopatogênese da Síndrome Inflamatória da Reconstituição Imune associada à criptococose. Conclusão: Apresentamos uma revisão dos estudos realizados sobre fatores de risco em biomarcadores no sangue e líquido cefalorraquidiano que podem auxiliar no diagnóstico de Síndrome Inflamatória da Reconstituição Imune na meningite criptococócica. Esses fatores de risco e biomarcadores podem ser usados para identificar pacientes que seriam submetidos a um monitoramento clínico mais rigoroso e com ajuste dos protocolos de tratamento em pacientes com AIDS coinfectados com Cryptococcus.

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Section: Aheah Of Printunclassified

Síndrome inflamatória da reconstituição imune associada à meningite criptococócica: fatores de risco e biomarcadores

Brienze

Andre

Liso

et al. 2021

ACS

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“…In countries with limited resources, cryptococcosis drives up to 40% of all hospitalizations and deaths associated with the advanced stage of HIV infection [3][4][5]. Immune reconstitution inflammatory syndrome associated with cryptococcosis (C-IRIS) is a common complication that manifests after the initiation of antiretroviral therapy (ART) [6,7]. Cryptococcal IRIS presents as an exaggerated and deregulated proinflammatory immune reaction, which accompanies the reduction in peripheral blood HIV viral load and the initiation of CD4+ T cell recovery [7].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the diagnosis of cryptococcal infection is essential for the prevention of unmasking CM-IRIS. The second form is "paradoxical" IRIS, which occurs in the settings of induction antifungal therapy [6,14]. Paradoxical CM-IRIS became the most common due to significant improvements in the diagnosis of cryptococcal meningitis and the introduction of antifungal therapy regimens prior to ART commencement [6,15].…”

Section: Introductionmentioning

confidence: 99%

“…The second form is "paradoxical" IRIS, which occurs in the settings of induction antifungal therapy [6,14]. Paradoxical CM-IRIS became the most common due to significant improvements in the diagnosis of cryptococcal meningitis and the introduction of antifungal therapy regimens prior to ART commencement [6,15]. The paradoxical form also presents itself as neuro-cryptococcosis, with clinical symptoms of worsening neurological function impairments and altered mental status due to raised intracranial/cerebrospinal fluid (CSF) pressure.…”

Section: Introductionmentioning

confidence: 99%

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Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Brienze

André

Liso

et al. 2021

Life

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Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage human immunodeficiency virus (HIV) infection who have commenced antiretroviral treatments (ART). Virtually any opportunistic pathogen can provoke this type of immune restoration disorder. In this review, we focus on recent developments in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the prediction and diagnosis of cryptococcal meningitis IRIS (CM-IRIS). We assess current therapeutic regimens and novel treatment approaches to combat CM-IRIS. We discuss the utility of biomarkers for clinical monitoring and adjusting treatment modalities in acquired immunodeficiency syndrome (AIDS) patients co-infected with Cryptococcus who have initiated ART.

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“…In countries with limited resources, cryptococcosis drives up to 40% of all hospitalizations and deaths associated with the advanced stage of HIV infection [3][4][5]. Immune reconstitution inflammatory syndrome (IRIS) associated with cryptococcosis is a common complication that manifests after the initiation of antiretroviral therapy (ART) [6,7]. Cryptococcal IRIS presents as an exaggerated and deregulated proinflammatory immune reaction, which accompanies the reduction of peripheral blood HIV viral load and the initiation of CD4+ T cell recovery [7].…”

Section: Introductionmentioning

confidence: 99%

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Brienze¹,

André²,

Liso³

et al. 2020

Preprint

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Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage HIV infection who commenced antiretroviral treatments. Virtually, any opportunistic pathogen can provoke this type of immune restoration disorders. In this review, we focus on recent development in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the diagnosis of cryptococcal meningitis IRIS. We assess the utility of these biomarkers to identify putative host-based targets, which may justify a clinical need for improvement in monitoring a patient’s laboratory results and adjusting treatment modalities in AIDS patients co-infected with Cryptococcus.

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Distinct paradoxical inflammatory reaction followed by postantiretroviral therapy immune reconstitution syndrome in cryptococcal meningitis

Cited by 5 publications

References 10 publications

Síndrome inflamatória da reconstituição imune associada à meningite criptococócica: fatores de risco e biomarcadores

Síndrome inflamatória da reconstituição imune associada à meningite criptococócica: fatores de risco e biomarcadores

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

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