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Immune Reconstitution Inflammatory Syndrome [IRIS]
Learning ObjectivesImmune Reconstitution Inflammatory Syndrome
Paradoxical Reaction
Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs, or radiographic manifestation of TB after beginning TB treatment due to simultaneous administration of Anti-retroviral Treatment (ART) and TB medication. It was thought to be a result of immune reconstitution and is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS).
Symptoms and Signs
- High fever
- Lymphadenopathy
- Expanding intrathoracic lesions
- Worsening of chest radiographic findings
Diagnosis: Made only after a thorough evaluation has excluded other etiologies, particularly where TB treatment has failed
Treatment: For severe paradoxical reactions, prednisolone (1–2 mg/kg for 1–2 weeks, then gradually decreasing dose) may be used.
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- WHO Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.
- Technical and Operational Guidelines for TB in India, 2016.
- Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.
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