scholarly journals Extensive central nervous system cryptococcal disease presenting as immune reconstitution syndrome in a patient with advanced HIV: report of a case and review of management dilemmas and strategies

2014 ◽  
Vol 6 (4) ◽  
Author(s):  
Onyema Ogbuagu ◽  
Merceditas Villanueva
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Immune Reconstitution ◽  
Treatment Guidelines ◽  
Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Cryptococcal Disease ◽  
Intracranial Cysts ◽  
Inflammatory Syndrome ◽  
Acquired Immune Deficiency

One of the complications of the use of anti-retroviral therapy (ART), immune reconstitution inflammatory syndrome (IRIS), is particularly problematic in the management of cryptococcal meningitis. We present the case of a 35- year-old male with acquired immune deficiency syndrome diagnosed with extensive central nervous system (CNS) cryptococcal disease, including meningitis and multiple intracranial cysts, diagnosed eight weeks after the initiation of ART. The patient experienced a relapsing and remitting clinical course despite repeated courses of potent antifungal therapy and aggressive management of raised intracranial pressure. This review highlights therapeutic dilemmas and strategies in the management of CNS cryptococcosis complicated with IRIS and highlights gaps in available treatment guidelines.

scholarly journals Mouse brain CD4 transcripts encode only the COOH-terminal half of the protein.

1988 ◽  
Vol 8 (5) ◽  
pp. 2224-2228 ◽  
Author(s):  
N Lonberg ◽  
S N Gettner ◽  
E Lacy ◽  
D R Littman
Keyword(s):  
Immune Deficiency ◽  
Central Nervous System ◽  
Nervous System ◽  
Major Histocompatibility Complex ◽  
Cell Surface ◽  
Immune Deficiency Syndrome ◽  
Acquired Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Histocompatibility Complex ◽  
Acquired Immune Deficiency

The T-cell surface glycoprotein CD4 is thought to function as a receptor for class II major histocompatibility complex molecules. Human CD4 is also the lymphoid cell receptor for human immunodeficiency virus, the causative agent of acquired immune deficiency syndrome. The observed infection of the central nervous system in acquired immune deficiency syndrome patients raises the possibility that CD4 is also present in nerve tissue and that a cell surface receptor for class II major histocompatibility complex antigens could play a role in central nervous system function. This possibility is reinforced by the detection of unique CD4-related transcripts in mouse and human brain tissue. In this study, the structure of the mouse brain CD4 transcript was determined. It is identical to the last two-thirds of the CD4 message and is capable of encoding a 217-residue protein that would consist of a truncated, 154-residue, cell surface region, together with the complete CD4 transmembrane and cytoplasmic regions. It would not include an amino-terminal hydrophobic leader peptide.

scholarly journals Case Report: Tuberculosis IRIS: a mediastinal problem

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 54 ◽  
Author(s):  
Leonardo Valentin ◽  
Andrew DiNardo ◽  
Elizabeth Chiao ◽  
Laila Woc-Colburn ◽  
Arun Nachiappan
Keyword(s):  
Immune Deficiency ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Immune Deficiency Syndrome ◽  
Acquired Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Esophageal Wall ◽  
Highly Active ◽  
Inflammatory Syndrome ◽  
Acquired Immune Deficiency

We present a case of a 39-year-old male patient with Acquired Immune Deficiency Syndrome (AIDS) who developed Mycobacterium tuberculosis related Immune Reconstitution Inflammatory Syndrome (IRIS) after initiation of Highly Active Antiretroviral Therapy (HAART) treatment. The inflammatory response resulted in mediastinal necrotic lymphadenopathy and subsequent perforation of the esophageal wall.

scholarly journals An Exclusively Skewed Distribution of Pediatric Immune Reconstitution Inflammatory Syndrome Towards the Female Sex is Associated with Advanced Acquired Immune Deficiency Syndrome

2019 ◽  
Author(s):  
Regina Célia de Souza Campos Fernandes ◽  
Thaís Louvain de Souza ◽  
Thiago da Silva Barcellos ◽  
Enrique Medina-Acosta
Keyword(s):  
Immune Deficiency ◽  
Immune Reconstitution ◽  
Immune Deficiency Syndrome ◽  
Acquired Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Skewed Distribution ◽  
Female Sex ◽  
Inflammatory Syndrome ◽  
Acquired Immune Deficiency ◽  
Hiv Aids

AbstractIn human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) patients with very low CD4 cell counts, there is a temporal relationship between administration of antiretroviral therapy (ART) and an increased inflammatory response state known as the immune reconstitution inflammatory syndrome (IRIS). The predominant clinical presentation of IRIS is an infectious disease that can be life-threatening. IRIS-related infectious events are distributed similarly between adult males and females, albeit a few studies have shown a skewing towards the male sex in pediatric IRIS. Here, we assessed sex-specific differences in the causes and extent of IRIS infectious events in HIV-infected pediatric patients on ART. We carried out a prospective clinical analysis (from 2000 to 2018) of IRIS-related infectious events after ART in a cohort of 82 Brazilian children and adolescents infected with HIV-1 through mother-to-child transmission as well as a comprehensive cross-referencing with public records on IRIS-related infectious causes in pediatric HIV/AIDS. Twelve events fulfilling the criteria of IRIS occurred exclusively in eleven females in our cohort. The median age at IRIS events was 3.6 years. The infectious causes included Mycobacterium bovis, varicella-zoster virus, molluscum contagiosum virus, human papillomavirus, cytomegalovirus, and Mycobacterium tuberculosis. In one female, there was regional bacillus Calmette-Guérin dissemination and cytomegalovirus esophagitis. There was complete health recovery after ten IRIS events without the use of corticosteroids or ART interruption. One case of IRIS-associated miliary tuberculosis was fatal. The biological female sex was a significant risk factor for IRIS events (odds ratio: 23.67; 95% confidence interval 95%: 1.341 – 417.7; P = 0.0016). We observed an effect of the advanced HIV/AIDS variable in IRIS females as compared with non-IRIS females (mean CD4+ T cell percentage 13.36% versus 18.63%; P = 0.0489), underpinning the exclusively skewed distribution towards the female sex of this cohort. Moreover, the IRIS females in our cohort had higher mean CD4+ T cell percentages before (13.36%) and after IRIS (26.56%) than those of the IRIS females (before IRIS, 4.978%; after IRIS, 13.81%) in previous studies conducted worldwide. We concluded that the exclusively skewed distribution of pediatric IRIS towards females is associated with more advanced AIDS.

Mouse brain CD4 transcripts encode only the COOH-terminal half of the protein

1988 ◽  
Vol 8 (5) ◽  
pp. 2224-2228
Author(s):  
N Lonberg ◽  
S N Gettner ◽  
E Lacy ◽  
D R Littman
Keyword(s):  
Immune Deficiency ◽  
Central Nervous System ◽  
Nervous System ◽  
Major Histocompatibility Complex ◽  
Cell Surface ◽  
Immune Deficiency Syndrome ◽  
Acquired Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Histocompatibility Complex ◽  
Acquired Immune Deficiency

The T-cell surface glycoprotein CD4 is thought to function as a receptor for class II major histocompatibility complex molecules. Human CD4 is also the lymphoid cell receptor for human immunodeficiency virus, the causative agent of acquired immune deficiency syndrome. The observed infection of the central nervous system in acquired immune deficiency syndrome patients raises the possibility that CD4 is also present in nerve tissue and that a cell surface receptor for class II major histocompatibility complex antigens could play a role in central nervous system function. This possibility is reinforced by the detection of unique CD4-related transcripts in mouse and human brain tissue. In this study, the structure of the mouse brain CD4 transcript was determined. It is identical to the last two-thirds of the CD4 message and is capable of encoding a 217-residue protein that would consist of a truncated, 154-residue, cell surface region, together with the complete CD4 transmembrane and cytoplasmic regions. It would not include an amino-terminal hydrophobic leader peptide.

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