PMID- 22389746
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220330
IS  - 1936-3761 (Print)
IS  - 1936-377X (Electronic)
IS  - 1936-3761 (Linking)
VI  - 5
IP  - 4
DP  - 2011 Dec 1
TI  - Cryptococcus-Related Immune Reconstitution Inflammatory Syndrome(IRIS): 
      Pathogenesis and Its Clinical Implications.
PG  - 252-261
AB  - This review provides an overview of Cryptococcus neoformans immunology and 
      focuses on the pathogenesis of Cryptococcus-related paradoxical immune 
      reconstitution inflammatory syndrome (IRIS). Cryptococcal IRIS has three phases: 
      (1) before antiretroviral therapy (ART), with a paucity of cerebrospinal fluid 
      (CSF) inflammation and defects in antigen clearance; (2) during initial ART 
      immune recovery, with pro-inflammatory signaling by antigen-presenting cells 
      without an effector response; and (3) at IRIS, a cytokine storm with a 
      predominant type-1 helper T-cell (Th(1)) interferon-gamma (IFN-gamma) response. 
      Understanding IRIS pathogenesis allows for risk stratification and customization 
      of HIV/AIDS care. In brief, persons at high IRIS risk may benefit from enhancing 
      microbiologic clearance by use of adjunctive agents in combination with 
      amphotericin, prolonging initial induction therapy, and/or increasing the initial 
      consolidation antifungal therapy dose to at least 800 mg of fluconazole daily 
      until the 2-week CSF culture is known to be sterile. Prophylactic 
      anti-inflammatory therapies or undue delay of ART initiation in an attempt to 
      prevent IRIS is unwarranted and may be dangerous.
FAU - Wiesner, Darin L
AU  - Wiesner DL
AD  - Division of Infectious Disease & International Medicine, Department of Medicine, 
      University of Minnesota, Minneapolis, MN, USA.
FAU - Boulware, David R
AU  - Boulware DR
LA  - eng
GR  - U01 AI089244/AI/NIAID NIH HHS/United States
GR  - K23 AI073192-02/AI/NIAID NIH HHS/United States
GR  - L30 AI066779/AI/NIAID NIH HHS/United States
GR  - L30 AI066779-04/AI/NIAID NIH HHS/United States
GR  - K23 AI073192/AI/NIAID NIH HHS/United States
GR  - U01 AI089244-01/AI/NIAID NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Curr Fungal Infect Rep
JT  - Current fungal infection reports
JID - 101306636
PMC - PMC3289516
MID - NIHMS316844
COIS- Disclosure Conflicts of Interest: D. Wiesner: none; D. Boulware: research support 
      from GlaxoSmithKline's HIV Collaborative Investigator Research Award and Merck's 
      Investigator-Initiated Studies Program; both of these firms manufacture HIV 
      antiretroviral medications.
EDAT- 2012/03/06 06:00
MHDA- 2012/03/06 06:01
PMCR- 2012/12/01
CRDT- 2012/03/06 06:00
PHST- 2012/03/06 06:00 [entrez]
PHST- 2012/03/06 06:00 [pubmed]
PHST- 2012/03/06 06:01 [medline]
PHST- 2012/12/01 00:00 [pmc-release]
AID - 10.1007/s12281-011-0064-8 [doi]
PST - ppublish
SO  - Curr Fungal Infect Rep. 2011 Dec 1;5(4):252-261. doi: 10.1007/s12281-011-0064-8.