Neurologic Manifestations of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series
Neurologic Manifestations of Paradoxical Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome: A Case Series
复制标题
DOI：
10.1086/598988
复制
发表时间：
2009-06-01
影响因子：
11.8
通讯作者：
Meintjes, Graeme
中科院分区：
文献类型：
--
作者：
Pepper, Dominique J.;Marais, Suzaan;Meintjes, Graeme
背景。悖论性神经结核相关免疫重建炎症综合征（TB-IRIS）是一种可能危及生命的疾病，发生在开始联合抗逆转录病毒治疗（ART）后3个月内。已发表的文献报道都是道听途说，神经系统结核- iris的患病率和预后尚不清楚。我们前瞻性地评估了2005年6月至2007年10月在南非开普敦我们医院的疑似结核- iris患者。我们使用一致的临床病例定义定义了悖论性TB-IRIS和悖论性神经学TB-IRIS。我们收集了有关结核病诊断、抗逆转录病毒治疗、结核病- iris诊断细节、其他机会性感染、皮质类固醇使用和结果的数据。我们回顾了279例疑似结核- iris患者，其中54例（19%）为疑似神经性结核- iris， 225例（81%）为疑似非神经性结核- iris。在190例患者中诊断出矛盾的TB-IRIS；这190例患者中有23例（12%）患有神经性TB-IRIS（95%可信区间，7%-17%）。8例患有脑膜炎，7例患有结核瘤，5例同时患有结核瘤和脑膜炎，3例患有神经根性脊髓病。23例神经性TB-IRIS患者中有20例（87%）需要住院治疗（中位持续时间为12天，四分位数范围为6-24天），21例（91%）接受皮质类固醇治疗（中位持续时间为58天，四分位数范围为29-86天）。初步评估神经系统恶化后6个月的结果如下：16例（70%）患者存活（其中10例身心完全恢复），3例（13%）死亡，4例（17%）失访。矛盾神经性结核病- iris占矛盾性结核病- iris病例的12%。神经性结核- iris引起相当大的短期发病率，但具有合理的长期预后。对于开始抗逆转录病毒治疗后出现神经功能恶化的结核病患者，需要进一步的研究来制定最佳的诊断和管理策略。
Background. Paradoxical neurologic tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is a potentially life-threatening condition that occurs within 3 months after starting combination antiretroviral therapy (ART). The reports in the published literature are anecdotal, and the prevalence and outcomes of neurologic TB-IRIS are unknown.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.