Table 2 Immune reconstitution inflammatory syndrome with disseminated Penicillium marneffei infection in HIV-infected patients: Literature review
Case | Country reported year | Age (yr) | Sex | Status before ART commencement | Type of ART | Type of IRIS | Time to IRIS onse | Status during IRIS presentation | Method for diagnosis | Treatments | Outcomes | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Â | Â | Â | Â | Clinical symptoms | CD4 cell count (cells/mm3) | Viral load (copies/mL) | Â | Â | Â | Clinical symptoms | CD4 cell count (cells/mm3) | Viral load (copies/mL) | Â | Â | Â |
1 | India24, 2007 | 35 | M | fever, loss of weight and appetite, hepatosplenomegaly, herpes genitalis | 4 | NA | d4T, 3TC, NVP | unmasking | 4 weeks | afebrile, pallor, mild icterus, cervical and axillary lymphadenopathy, hepatosplenomegaly | NA | NA | axillary LN biopsy-positive, LN culture-positive blood culture -positive, | AmphoB 0.6 MKD for 14 days, followed by itraconazole 400 mg/d for 10 wks, then MT with 200 mg/d | At 10 mo; 20 kg weight gain, decrease size of LN, liver, spleen, CD4 = 224 cells/mm3 |
2 | India25, 2009 | 12 | M | fever, cough, weight loss, diarrhea, generalized papular umbilicated lesion, oral and esophageal candidiasis | 11 | NA | d4T, 3TC, EFV | paradoxical | 4 weeks | fever, severe arthritis, exacerbration of skin lesions, generalised lymphadenopathy | 172 (wk 4) | NA | blood culture-positive | NA | NA |
3 | India26, 2010 | 28 | M | fever, cough, loss of weight, diarrhea, oral candidiasis | 47 | NA | d4T, 3TC, NVP | unmasking | 2 weeks | multiple erythrematous, scaly, papules and nodules with central necrosis on face extremities, scortum | 160 (wk 2) | NA | skin biopsy-positive, skin culture-positive, blood culture-negative | AmphoB 0.6 MKD only 1 dose, then itraconazole 400 mg/d for 2 mo, then MT with 200 mg/d | At 2 mo; 14 kg weight gain, skin lesions disappear |
4 | UK (traveled to Thailand)27, 2010 | 39 | M | fever, loss of weight and appetite, PJP, molluscum contangiosum on face | 72 | 38000000 | TDF, FTC, EFV | unmasking | 4 weeks | multiple facial lesions, disseminated non-pruritic nodules, no hepatosplenomegaly | 273 (wk 8) | 3 log drop (wk 4) | pus culture-positive | AmphoB 0.6 MKD for 14 days, followed by itraconazole 600 mg/d for 10 wks, then MT with 200 mg/d | At 2 mo; skin lesions regress At 28 mo; CD4 = 375 cells/mm3, VL < 50 copies/mL |
5 | Thailand, 2011 (Ours) | 14 | F | fever, loss of weight and appetite, PJP, herpes zoster on trunk | 39 | NA | d4T, 3TC, NVP | unmasking | 8 weeks | fever, severe osteoarthritis, disseminated non-pruritic papules and nodules with central necrosis, oral ulcer, no lymphadenopathy, no hepatosplenomegaly | 51 (wk 14) | < 50 (wk 14) | skin biopsy-positive, skin culture-negative, blood culture-negative | AmphoB 0.7 MKD for 14 days then Itraconazole 5 MK twice daily for 10 weeks, then MT with 5 MKD for 4 months | At 12 mo; 4 kg weight gain, CD4 = 269 cells/mm3, VL < 50 copies/mL |