Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in children.
Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in children.
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DOI：
10.1002/ppul.23221
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发表时间：
2016-02
影响因子：
3.1
通讯作者：
Moultrie H
中科院分区：
文献类型：
--
作者：
Van Rie A;Sawry S;Link-Gelles R;Madhi S;Fairlie L;Verwey C;Mahomed N;Murdoch D;Moultrie H
Paradoxical tuberculosis (TB)-associated Immune Reconstitution Inflammatory Syndrome (IRIS) is a common complication of combination antiretroviral treatment (cART) initiation in adults residing in resource-limited regions. Little is known about the burden and presentation of TB-IRIS in children initiating cART while receiving TB treatment. Prospective cohort study of South African children initiating cART while on TB treatment. Children were assessed clinically and by chest x-ray before starting cART and at 2, 4, 6, and 12 weeks post cART initiation. All children who presented with any signs or symptoms suggestive of paradoxical TB-IRIS were classified according to the consensus adult TB-IRIS case definition developed by the International Network for Study of HIV-associated IRIS (INSHI) and reviewed by an independent expert panel. In 7 of the 104 children enrolled in the cohort, symptoms and/or clinical or radiological signs suggestive of paradoxical TB-IRIS developed after a median of 14 days of cART. In two of these cases there was agreement between the INSHI case definition and the expert panel. In an additional 3 cases, the INSHI criteria were fulfilled but the expert panel made an alternative diagnosis of pneumonia (n=2) and poor adherence to cART (n=1). The burden of paradoxical TB-IRIS in children with underlying TB initiating cART is low. Including response to antibiotic treatment for pneumonia as a criterion for an alternative diagnosis may improve the specificity of the INSHI case definition.
