PMID- 38064539
OWN - NLM
STAT- MEDLINE
DCOM- 20240517
LR  - 20240517
IS  - 1445-5994 (Electronic)
IS  - 1444-0903 (Linking)
VI  - 54
IP  - 5
DP  - 2024 May
TI  - Incidence, risk factors and treatment of central nervous system immune 
      reconstitution inflammatory syndrome in non-HIV patients with tuberculous 
      meningitis: a multicentre observational study.
PG  - 802-808
LID - 10.1111/imj.16295 [doi]
AB  - BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) affecting the 
      central nervous system (CNS) is associated with poor outcomes. AIMS: To report on 
      risk factors for CNS-IRIS following tuberculous meningitis (TBM) in HIV-negative 
      patients. METHODS: In this retrospective multicentre study, all HIV-negative 
      adult patients admitted between 2003 and 2021 with microbiologically proven TBM 
      were included. The primary outcome measure was IRIS onset over follow-up. 
      Characteristics of patients who developed IRIS were described. Factors associated 
      with IRIS were identified using a multivariable logistic regression procedure. 
      RESULTS: Fifty-six patients (33.0 (27.0-44.3) years, 39 (69.6%) men) with 
      microbiologically proven TBM were studied. All patients received antituberculosis 
      treatment and 48 (n = 48/56; 85.7%) steroids at TBM diagnosis. During a median 
      follow-up of 18.0 (12.0-27.3) months, IRIS occurred in 28 (n = 28/56, 50.0%) 
      patients, at a median time of 2.0 (1.0-3.0) months after antituberculosis 
      treatment was started. IRIS involved the CNS in all but one case. Imaging 
      revealed new (n = 23/28, 82.1%) and/or worsening (n = 21/28; 75.0%) of previously 
      recognised lesions. Multivariable analysis showed that meningeal enhancement on 
      brain magnetic resonance imaging (MRI) (odds ratio (OR): 15.3; 95% confidence 
      interval (CI): (1.19-1193.5)) at TBM diagnosis and high blood albumin level (OR: 
      1.21; 95% CI: (1.02-1.60)) were associated with the occurrence of CNS-IRIS during 
      follow-up. CONCLUSION: CNS-IRIS following TBM in non-HIV patients appears 
      frequent and severe. Meningeal enhancement on brain MRI at tuberculosis diagnosis 
      is a risk factor for CNS-IRIS.
CI  - (c) 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons 
      Australia, Ltd on behalf of Royal Australasian College of Physicians.
FAU - Robert, Marie
AU  - Robert M
AD  - Service de Medecine Interne, Hopital Bichat, Assistance Publique - Hopitaux de 
      Paris (AP-HP), Paris, France.
FAU - Mageau, Arthur
AU  - Mageau A
AD  - Service de Medecine Interne, Hopital Bichat, Assistance Publique - Hopitaux de 
      Paris (AP-HP), Paris, France.
FAU - Gaudemer, Augustin
AU  - Gaudemer A
AD  - Service de Radiologie, Hopital Bichat, Assistance Publique - Hopitaux de Paris 
      (AP-HP), Paris, France.
FAU - Thy, Michael
AU  - Thy M
AD  - Service de Maladies infectieuses, Hopital Bichat, Assistance Publique - Hopitaux 
      de Paris (AP-HP), Paris, France.
FAU - Peiffer Smadja, Nathan
AU  - Peiffer Smadja N
AD  - Service de Maladies infectieuses, Hopital Bichat, Assistance Publique - Hopitaux 
      de Paris (AP-HP), Paris, France.
FAU - de Lastours, Victoire
AU  - de Lastours V
AD  - Service de Medecine Interne, Hopital Bichat, Assistance Publique - Hopitaux de 
      Paris (AP-HP), Paris, France.
FAU - De Broucker, Thomas
AU  - De Broucker T
AD  - Service de Neurologie, Hopital Delafontaine, Saint-Denis, France.
FAU - Papo, Thomas
AU  - Papo T
AD  - Service de Medecine Interne, Hopital Bichat, Assistance Publique - Hopitaux de 
      Paris (AP-HP), Paris, France.
AD  - Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculte de 
      Medecine site Bichat, Laboratoire d'Excellence, Inflamex, Universite de Paris, 
      Paris, France.
FAU - Goulenok, Tiphaine
AU  - Goulenok T
AD  - Service de Medecine Interne, Hopital Bichat, Assistance Publique - Hopitaux de 
      Paris (AP-HP), Paris, France.
FAU - Sacre, Karim
AU  - Sacre K
AD  - Service de Medecine Interne, Hopital Bichat, Assistance Publique - Hopitaux de 
      Paris (AP-HP), Paris, France.
AD  - Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculte de 
      Medecine site Bichat, Laboratoire d'Excellence, Inflamex, Universite de Paris, 
      Paris, France.
LA  - eng
GR  - Assistance Publique - Hopitaux de Paris/
GR  - Universite de Paris/
GR  - Ecole de l'Inserm Liliane Bettencourt Programme/
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20231208
PL  - Australia
TA  - Intern Med J
JT  - Internal medicine journal
JID - 101092952
SB  - IM
MH  - Humans
MH  - Male
MH  - *Immune Reconstitution Inflammatory Syndrome/epidemiology/chemically induced
MH  - Female
MH  - Adult
MH  - Retrospective Studies
MH  - *Tuberculosis, Meningeal/epidemiology/drug therapy/complications
MH  - Risk Factors
MH  - *Antitubercular Agents/therapeutic use/adverse effects
MH  - Incidence
MH  - Magnetic Resonance Imaging
OTO - NOTNLM
OT  - central nervous system
OT  - immune reconstitution inflammatory syndrome
OT  - risk factors
OT  - tuberculous meningitis
EDAT- 2023/12/08 18:42
MHDA- 2024/05/17 06:43
CRDT- 2023/12/08 13:53
PHST- 2023/05/28 00:00 [received]
PHST- 2023/10/15 00:00 [accepted]
PHST- 2024/05/17 06:43 [medline]
PHST- 2023/12/08 18:42 [pubmed]
PHST- 2023/12/08 13:53 [entrez]
AID - 10.1111/imj.16295 [doi]
PST - ppublish
SO  - Intern Med J. 2024 May;54(5):802-808. doi: 10.1111/imj.16295. Epub 2023 Dec 8.