PMID- 23203899
OWN - NLM
STAT- MEDLINE
DCOM- 20131029
LR  - 20220410
IS  - 1439-0973 (Electronic)
IS  - 0300-8126 (Linking)
VI  - 41
IP  - 2
DP  - 2013 Apr
TI  - Paradoxical reactions during treatment of tuberculosis with extrapulmonary 
      manifestations in HIV-negative patients.
PG  - 537-43
LID - 10.1007/s15010-012-0376-9 [doi]
AB  - PURPOSE: Tuberculous paradoxical reactions (PR) have been seldom studied in 
      non-immunocompromised patients. We conducted a study to describe the incidence, 
      clinical and biological features, treatment and outcome of PR in human 
      immunodeficiency virus (HIV)-negative patients treated for extrapulmonary 
      tuberculosis (TB) and to identify predictive factors of PR. METHODS: A 
      single-center retrospective study was conducted in consecutive HIV-negative 
      patients presenting with TB with at least one extrapulmonary manifestation who 
      were hospitalized in an internal medicine department between 2000 and 2010. 
      RESULTS: Seventy-six patients were enrolled in the study. Lymphadenitis was the 
      most common extrapulmonary manifestation of tuberculosis among this patient 
      population (72 %). PR occurred in 19 (25 %) patients, mostly involving the lymph 
      nodes (68 %) and lung (16 %), but also the pericardium, pleura, bone, muscle and 
      brain. Median time to PR onset after initiation of anti-TB regimen was 86 days 
      (interquartile range 36-125). Treatment of PR consisted mainly of corticosteroids 
      (47 % of patients) and needle aspiration of PR lymph nodes (31 %). Peripheral 
      lymph node involvement (p = 0.009), lymphopenia (p = 0.03) and anemia (p = 0.002) 
      at presentation were associated with PR occurrence. Outcome was favorable in all 
      patients with PR but one; the latter suffered residual paraplegia. CONCLUSIONS: 
      Paradoxical reactions are frequent in the course of extrapulmonary TB treatment 
      in HIV-negative patients but their outcome is excellent, except in some cases 
      with central nervous system involvement.
FAU - Geri, G
AU  - Geri G
AD  - Service de medecine interne, hopital europeen Georges Pompidou, Assistance 
      publique-hopitaux de Paris, 20 rue Leblanc, 75015, Paris, France.
FAU - Passeron, A
AU  - Passeron A
FAU - Heym, B
AU  - Heym B
FAU - Arlet, J-B
AU  - Arlet JB
FAU - Pouchot, J
AU  - Pouchot J
FAU - Capron, L
AU  - Capron L
FAU - Ranque, B
AU  - Ranque B
LA  - eng
PT  - Journal Article
DEP - 20121201
PL  - Germany
TA  - Infection
JT  - Infection
JID - 0365307
RN  - 0 (Antitubercular Agents)
SB  - IM
MH  - Adult
MH  - Anemia/microbiology/pathology
MH  - Antitubercular Agents/*adverse effects
MH  - Female
MH  - *HIV Seronegativity
MH  - Hospitalization
MH  - Humans
MH  - Incidence
MH  - Kaplan-Meier Estimate
MH  - Lung/pathology
MH  - Lymph Nodes/pathology
MH  - Lymphadenitis/microbiology
MH  - Male
MH  - Middle Aged
MH  - Pericardium/pathology
MH  - Pleura/microbiology/pathology
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Tuberculosis, Lymph Node/*drug therapy/microbiology/pathology
EDAT- 2012/12/04 06:00
MHDA- 2013/10/30 06:00
CRDT- 2012/12/04 06:00
PHST- 2012/08/31 00:00 [received]
PHST- 2012/11/19 00:00 [accepted]
PHST- 2012/12/04 06:00 [entrez]
PHST- 2012/12/04 06:00 [pubmed]
PHST- 2013/10/30 06:00 [medline]
AID - 10.1007/s15010-012-0376-9 [doi]
PST - ppublish
SO  - Infection. 2013 Apr;41(2):537-43. doi: 10.1007/s15010-012-0376-9. Epub 2012 Dec 
      1.