PMID- 16321643
OWN - NLM
STAT- MEDLINE
DCOM- 20060628
LR  - 20131121
IS  - 1532-2742 (Electronic)
IS  - 0163-4453 (Linking)
VI  - 51
IP  - 5
DP  - 2005 Dec
TI  - Cryptococcal immune reconstitution inflammatory syndrome: report of four cases in 
      three patients and review of the literature.
PG  - e289-97
AB  - Immune reconstitution inflammatory syndromes (IRIS) in patients with AIDS are 
      characterized by atypical manifestations of opportunistic pathogens in patients 
      experiencing improvement in CD4 cell counts following receipt of highly active 
      anti-retroviral therapy (HAART). We report four cases of IRIS due to Cryptococcus 
      neoformans in three patients and review the literature of cryptococcal IRIS in 
      AIDS (an additional 21 episodes). The IRIS presentation was lymphadenitis in all 
      three patients; one patient also had meningeal IRIS. Combining our patients with 
      the literature review revealed the following IRIS presentations: lymphadenitis 
      (n=14), central nervous system (CNS) IRIS (n=10): meningitis in six and mass 
      lesions in four, and pulmonary cavities (n=1). The median CD4 count of cases at 
      the time of initial cryptococcal diagnosis and prior to the start of HAART was 25 
      cells/microl and the median HIV viral load was 439,053 copies/ml. At time of 
      presentation of the IRIS, the median CD4 count had increased by 197 cells/microl. 
      The median time from initial cryptococcal diagnosis and the start of HAART to the 
      IRIS was 11 months (range 7 weeks to 3 years) and 7 months (range <2 weeks to 22 
      months), respectively. Patients with CNS IRIS tended to have shorter intervals 
      from initiation of HAART to presentation compared to patients with lymphadenitis: 
      median 3.5 months compared to 7 months. In 24 of 25 cases, the clinical 
      manifestations of the IRIS resolved (range: days to months). Only four patients 
      were given anti-inflammatory medications: corticosteroids in two and 
      non-steroidal anti-inflammatory drugs in two, thus precluding assessment of 
      efficacy. Patients with cryptococcal disease who initiate HAART are at risk for 
      cryptococcal IRIS.
FAU - Skiest, Daniel J
AU  - Skiest DJ
AD  - Division of Infectious Diseases, Department of Medicine, The University of Texas 
      Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9113, USA. 
      daniel.skiest@utsouthwestern.edu
FAU - Hester, L Jill
AU  - Hester LJ
FAU - Hardy, R Doug
AU  - Hardy RD
LA  - eng
GR  - U01 AI046376/AI/NIAID NIH HHS/United States
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Review
PL  - England
TA  - J Infect
JT  - The Journal of infection
JID - 7908424
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antifungal Agents)
RN  - 7XU7A7DROE (Amphotericin B)
RN  - 8VZV102JFY (Fluconazole)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*complications/drug therapy
MH  - Acquired Immunodeficiency Syndrome/*complications/drug therapy
MH  - Adult
MH  - Amphotericin B/therapeutic use
MH  - Anti-HIV Agents/therapeutic use
MH  - Antifungal Agents/therapeutic use
MH  - Antiretroviral Therapy, Highly Active
MH  - CD4 Lymphocyte Count
MH  - Cryptococcus neoformans/*isolation & purification
MH  - Female
MH  - Fluconazole/therapeutic use
MH  - Humans
MH  - Lymphadenitis/*complications/drug therapy
MH  - Male
MH  - Meningitis, Cryptococcal/*complications/drug therapy
RF  - 26
EDAT- 2005/12/03 09:00
MHDA- 2006/06/29 09:00
CRDT- 2005/12/03 09:00
PHST- 2005/02/25 00:00 [accepted]
PHST- 2005/12/03 09:00 [pubmed]
PHST- 2006/06/29 09:00 [medline]
PHST- 2005/12/03 09:00 [entrez]
AID - S0163-4453(05)00071-X [pii]
AID - 10.1016/j.jinf.2005.02.031 [doi]
PST - ppublish
SO  - J Infect. 2005 Dec;51(5):e289-97. doi: 10.1016/j.jinf.2005.02.031.