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Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors

Overview of attention for article published in BMC Infectious Diseases, September 2016
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Title
Prolonged tuberculosis-associated immune reconstitution inflammatory syndrome: characteristics and risk factors
Published in
BMC Infectious Diseases, September 2016
DOI 10.1186/s12879-016-1850-2
Pubmed ID
Authors

Tasnim M. Bana, Maia Lesosky, Dominique J. Pepper, Helen van der Plas, Charlotte Schutz, Rene Goliath, Chelsea Morroni, Marc Mendelson, Gary Maartens, Robert J. Wilkinson, Graeme Meintjes

Abstract

In a proportion of patients with HIV-associated tuberculosis who develop paradoxical immune reconstitution inflammatory syndrome (IRIS), the clinical course of IRIS is prolonged necessitating substantial health care utilization for diagnostic and therapeutic interventions. Prolonged TB-IRIS has not been prospectively studied to date. We aimed to determine the proportion of patients with prolonged TB-IRIS, as well as the clinical characteristics and risk factors for prolonged TB-IRIS. We pooled data from two prospective observational studies and a randomized controlled trial conducted in Cape Town, South Africa, that enrolled patients with paradoxical TB-IRIS. We used the same diagnostic approach and clinical case definitions for TB-IRIS in the 3 studies. Prolonged TB-IRIS was defined as TB-IRIS symptoms lasting > 90 days. Risk factors for prolonged TB-IRIS were analysed using Wilcoxon rank sum test, Fisher's exact test, multivariate logistic regression and Cox proportional hazards models. Two-hundred and sixteen patients with TB-IRIS were included. The median duration of TB-IRIS symptoms was 71.0 days (IQR 41.0-113.2). In 73/181 patients (40.3 %) with adequate follow-up data, IRIS duration was > 90 days. Six patients (3.3 %), mainly with lymph node involvement, had IRIS duration > 1 year. In univariate logistic regression analysis the following were significantly associated with IRIS duration > 90 days: lymph node involvement at initial TB diagnosis, drug-resistant TB, lymph node TB-IRIS, and not being hospitalised at time of TB-IRIS diagnosis. In our multivariate logistic regression model lymph node TB-IRIS (aOR 2.27, 95 % CI 1.13-4.59) and not being hospitalised at time of TB-IRIS diagnosis (aOR for being hospitalised 0.5, 95 % CI 0.25-0.99) remained significantly associated with prolonged TB-IRIS, and drug-resistant TB was of borderline significance (aOR 3.26, 95 % CI 0.97-12.99). The association of not being hospitalised with longer duration of IRIS might be related to 1 of the 3 cohorts in which all patients were hospitalised at ART initiation with close inpatient follow-up. This could have resulted in diagnosis of milder cases and earlier IRIS treatment potentially resulting in shorter TB-IRIS duration in these hospitalised patients. Around 40 % of patients with TB-IRIS have symptoms for more than 90 days. Involvement of lymph nodes at time of TB-IRIS is an independent risk factor for prolonged TB-IRIS. Future studies should address whether more prompt anti-inflammatory treatment of lymph node TB-IRIS reduces the risk of prolonged TB-IRIS. The randomized controlled trial was registered with Current Controlled Trials ISRCTN21322548 on 17 August 2005.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 38 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 38 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 8 21%
Other 7 18%
Student > Bachelor 4 11%
Student > Ph. D. Student 4 11%
Professor > Associate Professor 3 8%
Other 8 21%
Unknown 4 11%
Readers by discipline Count As %
Medicine and Dentistry 15 39%
Biochemistry, Genetics and Molecular Biology 3 8%
Nursing and Health Professions 2 5%
Agricultural and Biological Sciences 2 5%
Immunology and Microbiology 2 5%
Other 4 11%
Unknown 10 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 03 January 2017.
All research outputs
#7,675,171
of 8,849,667 outputs
Outputs from BMC Infectious Diseases
#3,514
of 3,927 outputs
Outputs of similar age
#247,428
of 301,697 outputs
Outputs of similar age from BMC Infectious Diseases
#122
of 165 outputs
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