Incidence, risk factors and treatment of central nervous system immune reconstitution inflammatory syndrome in non‐HIV patients with tuberculous meningitis: a multicentre observational study.

Autor:	Robert, Marie, Mageau, Arthur, Gaudemer, Augustin, Thy, Michael, Peiffer Smadja, Nathan, de Lastours, Victoire, De Broucker, Thomas, Papo, Thomas, Goulenok, Tiphaine, Sacré, Karim
Předmět:	RISK assessment STEROIDS RESEARCH funding IMMUNE reconstitution inflammatory syndrome SCIENTIFIC observation LOGISTIC regression analysis RETROSPECTIVE studies DESCRIPTIVE statistics MULTIVARIATE analysis MAGNETIC resonance imaging ODDS ratio ANTITUBERCULAR agents RESEARCH CENTRAL nervous system diseases CONFIDENCE intervals DISEASE incidence PATIENT aftercare SERUM albumin BIOMARKERS DISEASE risk factors
Zdroj:	Internal Medicine Journal; May2024, Vol. 54 Issue 5, p802-808, 7p
Abstrakt:	Background: Immune reconstitution inflammatory syndrome (IRIS) affecting the central nervous system (CNS) is associated with poor outcomes. Aims: To report on risk factors for CNS‐IRIS following tuberculous meningitis (TBM) in HIV‐negative patients. Methods: In this retrospective multicentre study, all HIV‐negative adult patients admitted between 2003 and 2021 with microbiologically proven TBM were included. The primary outcome measure was IRIS onset over follow‐up. Characteristics of patients who developed IRIS were described. Factors associated with IRIS were identified using a multivariable logistic regression procedure. Results: Fifty‐six patients (33.0 (27.0–44.3) years, 39 (69.6%) men) with microbiologically proven TBM were studied. All patients received antituberculosis treatment and 48 (n = 48/56; 85.7%) steroids at TBM diagnosis. During a median follow‐up of 18.0 (12.0–27.3) months, IRIS occurred in 28 (n = 28/56, 50.0%) patients, at a median time of 2.0 (1.0–3.0) months after antituberculosis treatment was started. IRIS involved the CNS in all but one case. Imaging revealed new (n = 23/28, 82.1%) and/or worsening (n = 21/28; 75.0%) of previously recognised lesions. Multivariable analysis showed that meningeal enhancement on brain magnetic resonance imaging (MRI) (odds ratio (OR): 15.3; 95% confidence interval (CI): (1.19–1193.5)) at TBM diagnosis and high blood albumin level (OR: 1.21; 95% CI: (1.02–1.60)) were associated with the occurrence of CNS‐IRIS during follow‐up. Conclusion: CNS‐IRIS following TBM in non‐HIV patients appears frequent and severe. Meningeal enhancement on brain MRI at tuberculosis diagnosis is a risk factor for CNS‐IRIS. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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