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Toxoplasmic encephalitis IRIS in HIV-infected patients: a case series and review of the literature.
MedLine Citation:
PMID:  20660912     Owner:  NLM     Status:  In-Data-Review    
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/μl (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.
Guillaume Martin-Blondel; Muriel Alvarez; Pierre Delobel; Emmanuelle Uro-Coste; Lise Cuzin; Victor Cuvinciuc; Judith Fillaux; Patrice Massip; Bruno Marchou
Publication Detail:
Type:  Journal Article     Date:  2010-07-26
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  82     ISSN:  1468-330X     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  691-3     Citation Subset:  IM    
Infectious and Tropical Diseases Department, Toulouse University Hospital, Place du Docteur Baylac TSA 40031, 31059 Toulouse cedex 9, France;
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