Immunorestitution Disease Involving the Innate and Adaptive Response
Open Access
- 1 June 2000
- journal article
- case report
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 30 (6), 882-892
- https://doi.org/10.1086/313809
Abstract
Immunorestitution disease (IRD) is defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexisting infection that is temporally related to the recovery of the immune system. We report the temporal sequence of events that led to IRD caused by Pneumocystis carinii and Aspergillus terreus in 2 human immunodeficiency virus (HIV)—negative patients soon after the recovery of adaptive and innate immunity, respectively, and we review episodes noted in the English-language literature that fit the definition of IRD (109 episodes in 107 patients). The median time from the recovery of neutrophil counts or termination of steroid therapy to the development of IRD was 8 days in cases of pulmonary aspergillosis (23 episodes) and hepatosplenic candidiasis (8) and 21 days for viral diseases such as hepatitis B (24) and viral pneumonitis (6). For IRD due to mycobacteriosis (27 episodes) and cryptococcosis (4) in HIV-positive patients, the median interval between the initiation of highly active antiretroviral therapy (HAART) and the onset of IRD was 11 days; for viral infections, including those due to cytomegalovirus (14), hepatitis B virus (1), and hepatitis C virus (2), the median interval was 42 days. As an emerging clinical entity, IRD merits further study to optimize treatment of immunosuppressed patients.Keywords
This publication has 40 references indexed in Scilit:
- Systemic inflammatory reaction after starting highly active antiretroviral therapy in AIDS patients treated for extrapulmonary tuberculosisAmerican Journal Of Medicine, 1999
- Paradoxical Reactions in HIV and Pulmonary TBChest, 1998
- Recovery of the Immune System With Antiretroviral TherapyJAMA, 1998
- Paradoxical Worsening of Tuberculosis Following Antiretroviral Therapy in Patients with AIDSAmerican Journal of Respiratory and Critical Care Medicine, 1998
- Immune Recovery Vitritis Associated With Inactive Cytomegalovirus RetinitisAmerican Journal of Ophthalmology, 1998
- Regression of Cytomegalovirus Retinitis Associated With Protease-inhibitor Treatment in Patients With AIDSAmerican Journal of Ophthalmology, 1997
- Cytomegalovirus retinitis after initiation of highly active antiretroviral therapyThe Lancet, 1997
- Detection of CMV DNA in bone marrow transplant recipients: plasma versus leucocyte polymerase chain reaction.Journal of Clinical Pathology, 1997
- DIRECT DETECTION OF CYTOMEGALOVIRUS IN PERIPHERAL BLOOD LEUKOCYTES-A REVIEW OF THE ANTIGENEMIA ASSAY AND POLYMERASE CHAIN REACTIONTransplantation, 1992
- Pneumocystis cariniiPneumonia: Differences in Lung Parasite Number and Inflammation in Patients with and without AIDSAmerican Review of Respiratory Disease, 1989