PMID- 20660912
OWN - NLM
STAT- MEDLINE
DCOM- 20110712
LR  - 20220316
IS  - 1468-330X (Electronic)
IS  - 0022-3050 (Linking)
VI  - 82
IP  - 6
DP  - 2011 Jun
TI  - Toxoplasmic encephalitis IRIS in HIV-infected patients: a case series and review 
      of the literature.
PG  - 691-3
LID - 10.1136/jnnp.2009.199919 [doi]
AB  - BACKGROUND: Toxoplasmic encephalitis associated with immune reconstitution 
      inflammatory syndrome (TE-IRIS) is rarely described. METHODS: To identify TE-IRIS 
      cases, the authors performed a retrospective study of all HIV-infected patients 
      diagnosed as having TE in our unit between January 2000 and June 2009, and a 
      review of published cases. RESULTS: Three patients out of 65 toxoplasmic 
      encephalitis (TE) cases, together with six from the literature, fulfilled the 
      unmasking TE-IRIS definition. None fulfilled the paradoxical TE-IRIS definition. 
      TE occurred within a median time of 48.5 days (IQ(25-75) 21-56) after starting 
      antiretroviral therapy. Cases did not have distinctive clinical or neuroimaging 
      features from TE occurring without immune reconstitution. However: (1) cases 
      occurred at a median CD4 lymphocytes count of 222/mul (IQ(25-75) 160-280); (2) TE 
      occurred in five patients who were supposed to take an effective 
      chemoprophylaxis; (3) two patients had a brain biopsy showing an intense 
      angiocentric inflammatory infiltrating with predominantly CD8 lymphocytes; (4) in 
      one patient, the abnormal length of evolution under treatment might be due to the 
      heightened immune response. CONCLUSION: Although rare, unmasking TE-IRIS exists 
      and might occur despite effective prophylaxis and an unusually high CD4 
      lymphocyte count. Immune reconstitution inflammatory syndrome does not modify TE 
      diagnosis and treatment but might extend its clinical course.
FAU - Martin-Blondel, Guillaume
AU  - Martin-Blondel G
AD  - Infectious and Tropical Diseases Department, Toulouse University Hospital, Place 
      du Docteur Baylac TSA 40031, 31059 Toulouse cedex 9, France. 
      guillaumemb@gmail.com
FAU - Alvarez, Muriel
AU  - Alvarez M
FAU - Delobel, Pierre
AU  - Delobel P
FAU - Uro-Coste, Emmanuelle
AU  - Uro-Coste E
FAU - Cuzin, Lise
AU  - Cuzin L
FAU - Cuvinciuc, Victor
AU  - Cuvinciuc V
FAU - Fillaux, Judith
AU  - Fillaux J
FAU - Massip, Patrice
AU  - Massip P
FAU - Marchou, Bruno
AU  - Marchou B
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20100726
PL  - England
TA  - J Neurol Neurosurg Psychiatry
JT  - Journal of neurology, neurosurgery, and psychiatry
JID - 2985191R
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*complications
MH  - Adult
MH  - Female
MH  - HIV Infections/*complications
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications
MH  - Male
MH  - Middle Aged
MH  - Toxoplasmosis, Cerebral/*complications
EDAT- 2010/07/28 06:00
MHDA- 2011/07/13 06:00
CRDT- 2010/07/28 06:00
PHST- 2010/07/28 06:00 [entrez]
PHST- 2010/07/28 06:00 [pubmed]
PHST- 2011/07/13 06:00 [medline]
AID - jnnp.2009.199919 [pii]
AID - 10.1136/jnnp.2009.199919 [doi]
PST - ppublish
SO  - J Neurol Neurosurg Psychiatry. 2011 Jun;82(6):691-3. doi: 
      10.1136/jnnp.2009.199919. Epub 2010 Jul 26.