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Chapter 38 : Paradoxical Reactions and the Immune Reconstitution Inflammatory Syndrome

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Abstract:

The immune response to mycobacterial infection is complex, involving several arms of the immune system. Organs are damaged by mycobacteria directly and also by the necrotic granulomatous immune response of the host to this pathogen. Ideally, mycobacterial infection is met with a balanced immune response that is sufficient to kill organisms but not so severe as to cause excessive tissue injury. Immunosuppression may promote growth of mycobacteria while decreasing tissue injury by the host response to the infection. Conversely, enhancement of the host’s immune response may kill more organisms but may also result in more organ damage.

Citation: Church L, Chopra A, Judson M. 2017. Paradoxical Reactions and the Immune Reconstitution Inflammatory Syndrome, p 637-652. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0033-2016
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Figures

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Figure 1

Chest X ray before and 3 months after initiation of ART, demonstrating a new left hilar mass (arrow). A chest computed tomography scan demonstrates a 2.0- by 2.0- by 2.5-cm heterogeneous mass just anterior to the left upper lobe bronchus. The lung parenchyma is normal, and no mediastinal adenopathy is present.

Citation: Church L, Chopra A, Judson M. 2017. Paradoxical Reactions and the Immune Reconstitution Inflammatory Syndrome, p 637-652. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0033-2016
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Tables

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Table 1

Clinical features: TB, paradoxical reaction, and IRIS

Citation: Church L, Chopra A, Judson M. 2017. Paradoxical Reactions and the Immune Reconstitution Inflammatory Syndrome, p 637-652. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0033-2016
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Table 2

Incidence: TB, paradoxical reaction, and IRIS

Citation: Church L, Chopra A, Judson M. 2017. Paradoxical Reactions and the Immune Reconstitution Inflammatory Syndrome, p 637-652. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0033-2016
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Table 3

Sarcoidosis and IRIS case reports

Citation: Church L, Chopra A, Judson M. 2017. Paradoxical Reactions and the Immune Reconstitution Inflammatory Syndrome, p 637-652. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0033-2016

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