Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions

被引：220

作者：

Haddow, Lewis J. ^{[1
,2
]}

Colebunders, Robert ^{[3
,4
]}

Meintjes, Graeme ^{[5
]}

Lawn, Stephen D. ^{[6
,7
]}

Elliott, Julian H. ^{[8
,9
]}

Manabe, Yukari C. ^{[10
,11
]}

Bohjanen, Paul R. ^{[12
,13
]}

Sungkanuparph, Somnuek ^{[14
]}

Easterbrook, Philippa J. ^{[1
,2
]}

French, Martyn A. ^{[15
,16
,17
]}

Boulware, David R. ^{[12
,13
]}

机构：

[1] Kings Coll London, Div Immunol Infect & Inflammatory Dis, London WC2R 2LS, England

[2] Univ KwaZulu Natal, Dept Infect Dis, Nelson R Mandela Sch Med, Durban, South Africa

[3] Inst Trop Med, B-2000 Antwerp, Belgium

[4] Univ Antwerp, B-2020 Antwerp, Belgium

[5] Univ Cape Town, Dept Med, Infect Dis Unit, GF Jooste Hosp, ZA-7700 Rondebosch, South Africa

[6] London Sch Hyg & Trop Med, Clin Res Unit, Dept Infect & Trop Dis, London WC1, England

[7] Univ Cape Town, Fac Hlth Sci, Desmond Tutu HIV Ctr, Inst Infect Dis & Mol Med, ZA-7925 Cape Town, South Africa

[8] Alfred Hosp, Infect Dis Unit, Melbourne, Vic, Australia

[9] Macfarlane Burnet Inst Med Res & Publ Hlth, Melbourne, Vic, Australia

[10] Makerere Univ, Sch Med, Infect Dis Inst, Kampala, Uganda

[11] Johns Hopkins Univ, Sch Med, Div Infect Dis, Dept Med, Baltimore, MD 21205 USA

[12] Univ Minnesota, Ctr Infect Dis & Microbiol Translat Res, Minneapolis, MN USA

[13] Univ Minnesota, Dept Med, Div Infect Dis & Int Med, Minneapolis, MN 55455 USA

[14] Mahidol Univ, Med Ramathibodi Hosp, Bangkok 10700, Thailand

[15] Univ Western Australia, Sch Pathol & Lab Med, Perth, WA 6009, Australia

[16] Royal Perth Hosp, Dept Clin Immunol, Perth, WA 6001, Australia

[17] PathW Lab Med, Perth, WA, Australia

来源：

LANCET INFECTIOUS DISEASES | 2010年 / 10卷 / 11期

基金：

英国惠康基金; 英国医学研究理事会;

关键词：

HIGH-DOSE FLUCONAZOLE; INCREASED INTRACRANIAL-PRESSURE; HIV COMBINATION THERAPY; ANTIRETROVIRAL THERAPY; RISK-FACTORS; OPPORTUNISTIC INFECTIONS; AMPHOTERICIN-B; POSITIVE PATIENTS; REVISED CRITERIA; EARLY MORTALITY;

D O I：

10.1016/S1473-3099(10)70170-5

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Cryptococcal immune reconstitution inflammatory syndrome (IRIS) may present as a clinical worsening or new presentation of cryptococcal disease after initiation of antiretroviral therapy (ART), and is thought to be caused by recovery of cryptococcus-specific immune responses. We have reviewed reports of cryptococcal IRIS and have developed a consensus case definition specifically for paradoxical crytopcoccal IRIS in patients with HIV-1 and known cryptococcal disease before ART, and a separate definition for incident cryptococcosis developed during ART (termed ART-associated cryptococcosis), for which a proportion of cases are likely to be unmasking cryptococcal IRIS. These structured case definitions are intended to aid design of future clinical, epidemiological, and immunopathological studies of cryptococcal IRIS, to standardise diagnostic criteria, and to facilitate comparisons between studies. As for definitions of tuberculosis-associated IRIS, definitions for cryptococcal IRIS should be regarded as preliminary until further insights into the immunopathology of IRIS permit their refinement.

引用

页码：791 / 802

页数：12

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