ABSTRACT
@#Introduction: Immune reconstitution inflammatory syndrome (IRIS) is paradoxical clinical deterioration experienced by some HIV-infected patients in response to antiretroviral therapy (ART). There is still limited published data on IRIS from this region including Malaysia. This study aimed to determine IRIS prevalence, clinical manifestations and possible predictors among HIV-infected patients in an infectious disease centre in Peninsular Malaysia. Method: This retrospective study was conducted in Hospital Sungai Buloh involving secondary data of 256 HIV-infected patients who were initiated on ART in the year 2017. Medical record of each patient was reviewed for up to 12 months following ART initiation to identify IRIS diagnosis which was made by the treating physician. Relevant clinical and laboratory information were retrieved from hospital electronic database. Results: IRIS has occurred in 17.6% of patients. Infections by Mycobacterium tuberculosis (53.3%), Pneumocystis jirovecii (11.1%) and Talaromyces marneffei (6.6%) were the commonest three aetiologies of IRIS. Subacute lupus erythematosus was the only non-infectious IRIS identified. Baseline HIV viral load, CD4+ T-cell count and haemoglobin level between IRIS and non-IRIS patients were significantly different. Risk of developing IRIS was increased seven times in patients with CD4+ T-cell count < 100 cells/µL and four times in patients with HIV RNA viral load > 5.5 log10 copies/ml prior to ART initiation. Conclusion: Mycobacterium tuberculosis infections were the highest IRIS manifestation. Although rare, non-infectious IRIS does occur and should be part of the differential diagnosis. Patients with positive predictors should be appropriately monitored for possible IRIS development once initiated on ART.
ABSTRACT
Diffuse lepromatous leprosy (DLL) is a severe clinical outcome of lepromatous leprosy (LL). The aetiologic cause is believed to be different from Mycobacterium leprae. A new species, Mycobacterium lepromatosis, was identified from a group of Mexican patients with DLL, and severe leprosy reactional state type 3 (Lucio's phenomenon). However, a total sequencing of its genome is necessary to prove the existence of this new species. This is a report on a non-typical Colombian case of leprosy - HIV coinfection, associated with an immune reconstitution inflammatory syndrome clinically compatible with a leprosy reaction type 3 or Lucio's phenomenon.
La lepra difusa (LLD) es una variedad de la lepra lepromatosa (LL), frecuente enMéxico. El agente etiológico se cree que es diferente a Mycobacterium leprae y se considerauna especie nueva denominada Mycobacterium lepromatosis, hecho que no se ha comprobado.El reporte de este caso se realiza para dar a conocer el cuadro clínico atípico que presentóuna paciente colombiana con coinfección VIH---LL variedad difusa (LLD), asociado a síndromede reconstitución inmunológica, compatible clínicamente con una leprorreacción tipo 3 o fenó-meno de Lucio.
Subject(s)
Humans , Female , Adult , Leprosy, Lepromatous , Immune Reconstitution Inflammatory Syndrome , Coinfection , Mycobacterium leprae , HIV Infections , HIV , Genome , Esocidae , Leprosy , MycobacteriumABSTRACT
Relatamos a ocorrência da Síndrome Inflamatória da RecuperaçãoImune (IRIS), após reversão de agranulocitose, induzida por poliquimioterapia,em paciente do sexo feminino acometida por hanseníasedimorfa-virchowiana. Propomos que em todos os pacientes submetidosà poliquimioterapia para hanseníase sejam efetuados periodicamenteexames laboratoriais que possam identificar precocementedistúrbios hematológicos graves
We report the occurrence of Immune Reconstitution InflammatorySyndrome (IRIS) after reversal of agranulocytosis provoked by drugor drugs used in the treatment of leprosy. After suspension of thedrugs under suspicion and the recovery of the hematologic disturbanceand as consequence the restoration of the immune conditionwe started an alternate treatment for Hansens disease. Takingthis case as an example, we propose that all patients with leprosyand under treatment with drugs such as dapsone and/ or rifampicinshould have a periodical hemogram to identify premature hematologicanomalies.