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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance
Clinical Infectious Diseases, Volume 48, No. 5, Year 2009
Notification
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Description
Background. Tuberculosis (TB) immune reconstitution inflammatory syndrome (IRIS) is emerging as an important early complication of combination antiretroviral therapy in patients with TB in developing countries. The differential diagnosis of TB IRIS includes deterioration caused by other human immunodeficiency virus-related morbidities and drug-resistant TB. Methods. We prospectively evaluated consecutive patients with suspected TB IRIS from February 2005 through July 2006 at a community-based secondary hospital in Cape Town, South Africa, by means of clinical case definitions for TB IRIS. Specimens were sent for TB culture and susceptibility testing, and a rapid test (FASTplaque-Response) was performed to expedite determination of rifampin susceptibility. Results. One hundred patients with suspected TB IRIS were evaluated, 26 of whom were being retreated for TB. IRIS symptoms developed a median of 14 days (interquartile range, 7-25 days) after the initiation of combination antiretroviral therapy. In 7 patients, an alternative opportunistic disease was diagnosed. Rifampin-resistant TB was present in 13 patients, 9 of whom received a diagnosis after study entry (7 of 9 had multidrug-resistant TB). Undiagnosed rifampin-resistant TB was thus present in 10.1% of patients (95% confidence interval, 3.9%-16.4%) who presented with TB IRIS, once those with alternative diagnoses and TB with known rifampin resistance were excluded. In the remaining 80 patients, TB IRIS without rifampin resistance was the final diagnosis. Conclusions. TB IRIS that is clinically indistinguishable from TB IRIS that occurs in the context of drug-susceptible disease may occur in patients with undiagnosed multidrug-resistant TB. Antitubercular drug resistance should be excluded in all cases of suspected TB IRIS, and corticosteroids should be used with caution for patients with presumed TB IRIS until the result of drug-susceptibility testing is known. © 2009 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Meintjes, Graeme Ayton
South Africa, Cape Town
University of Cape Town
South Africa, Cape Town
Gf Jooste Hospital
South Africa, Cape Town
Faculty of Health Sciences
Rangaka, Molebogeng Xheeda
South Africa, Cape Town
University of Cape Town
Maartens, Gary Tuberculosis
South Africa, Cape Town
University of Cape Town
Rebe, Kevin Brian
South Africa, Cape Town
University of Cape Town
South Africa, Cape Town
Gf Jooste Hospital
Morroni, Chelsea
South Africa, Cape Town
University of Cape Town
Pepper, Dominique J.
South Africa, Cape Town
University of Cape Town
South Africa, Cape Town
Gf Jooste Hospital
Andrea Wilkinson, Katalin Andrea
South Africa, Cape Town
University of Cape Town
United Kingdom, London
Mrc National Institute for Medical Research
Wilkinson, Robert J.
South Africa, Cape Town
University of Cape Town
South Africa, Cape Town
Gf Jooste Hospital
United Kingdom, London
Mrc National Institute for Medical Research
United Kingdom, London
Imperial College London
Statistics
Citations: 117
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1086/596764
ISSN:
10584838
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
South Africa