PMID- 19191655 OWN - NLM STAT- MEDLINE DCOM- 20090223 LR - 20230517 IS - 1537-6591 (Electronic) IS - 1058-4838 (Print) IS - 1058-4838 (Linking) VI - 48 IP - 5 DP - 2009 Mar 1 TI - Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance. PG - 667-76 LID - 10.1086/596764 [doi] AB - BACKGROUND: Tuberculosis (TB) immune reconstitution inflammatory syndrome (IRIS) is emerging as an important early complication of combination antiretroviral therapy in patients with TB in developing countries. The differential diagnosis of TB IRIS includes deterioration caused by other human immunodeficiency virus-related morbidities and drug-resistant TB. METHODS: We prospectively evaluated consecutive patients with suspected TB IRIS from February 2005 through July 2006 at a community-based secondary hospital in Cape Town, South Africa, by means of clinical case definitions for TB IRIS. Specimens were sent for TB culture and susceptibility testing, and a rapid test (FASTplaque-Response) was performed to expedite determination of rifampin susceptibility. RESULTS: One hundred patients with suspected TB IRIS were evaluated, 26 of whom were being retreated for TB. IRIS symptoms developed a median of 14 days (interquartile range, 7-25 days) after the initiation of combination antiretroviral therapy. In 7 patients, an alternative opportunistic disease was diagnosed. Rifampin-resistant TB was present in 13 patients, 9 of whom received a diagnosis after study entry (7 of 9 had multidrug-resistant TB). Undiagnosed rifampin-resistant TB was thus present in 10.1% of patients (95% confidence interval, 3.9%-16.4%) who presented with TB IRIS, once those with alternative diagnoses and TB with known rifampin resistance were excluded. In the remaining 80 patients, TB IRIS without rifampin resistance was the final diagnosis. CONCLUSIONS: TB IRIS that is clinically indistinguishable from TB IRIS that occurs in the context of drug-susceptible disease may occur in patients with undiagnosed multidrug-resistant TB. Antitubercular drug resistance should be excluded in all cases of suspected TB IRIS, and corticosteroids should be used with caution for patients with presumed TB IRIS until the result of drug-susceptibility testing is known. FAU - Meintjes, Graeme AU - Meintjes G AD - Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. graemein@mweb.co.za FAU - Rangaka, Molebogeng X AU - Rangaka MX FAU - Maartens, Gary AU - Maartens G FAU - Rebe, Kevin AU - Rebe K FAU - Morroni, Chelsea AU - Morroni C FAU - Pepper, Dominique J AU - Pepper DJ FAU - Wilkinson, Katalin A AU - Wilkinson KA FAU - Wilkinson, Robert J AU - Wilkinson RJ LA - eng GR - 081667/WT_/Wellcome Trust/United Kingdom GR - 084323/WT_/Wellcome Trust/United Kingdom GR - MC_U117588499/MRC_/Medical Research Council/United Kingdom GR - U117588499(88499)/MRC_/Medical Research Council/United Kingdom GR - 072070/WT_/Wellcome Trust/United Kingdom GR - WT_/Wellcome Trust/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Clin Infect Dis JT - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JID - 9203213 RN - 0 (Antitubercular Agents) SB - IM CIN - Clin Infect Dis. 2009 Mar 1;48(5):677-9. PMID: 19191656 MH - Antitubercular Agents/*pharmacology MH - *Drug Resistance, Bacterial MH - HIV Infections/complications/drug therapy MH - Humans MH - *Immune Reconstitution Inflammatory Syndrome MH - Microbial Sensitivity Tests MH - Mycobacterium tuberculosis/*drug effects/*immunology MH - Prospective Studies MH - South Africa MH - Tuberculosis/*drug therapy/*immunology/pathology PMC - PMC2737129 MID - UKMS27522 OID - NLM: UKMS27522 EDAT- 2009/02/05 09:00 MHDA- 2009/02/24 09:00 PMCR- 2009/09/03 CRDT- 2009/02/05 09:00 PHST- 2009/02/05 09:00 [entrez] PHST- 2009/02/05 09:00 [pubmed] PHST- 2009/02/24 09:00 [medline] PHST- 2009/09/03 00:00 [pmc-release] AID - 10.1086/596764 [pii] AID - 10.1086/596764 [doi] PST - ppublish SO - Clin Infect Dis. 2009 Mar 1;48(5):667-76. doi: 10.1086/596764.