INTENSIVIST Volume 11, Issue 1 (January 2019)

Immune reconstitution inflammatory syndrome Hideki YOSHIDA 1 , Shigeki FUJITANI 1,2 1Department of Emergency and Critical Care Medicine St. Marianna University Hospital 2Tokyo Bay Urayasu Ichikawa Medical Center pp.136-143
Published Date 2019/1/1
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Immune reconstitution inflammatory syndrome (IRIS) represents a clinical worsening of immune-mediated inflammation against an antigen along with immune recovery. There is no internationally accepted definition of IRIS. Dividing the series of event into three phases provide a clear understanding of IRIS, including the Immunosuppression phase, Immune recovery phase, and Onset phase. During the onset phase, IRIS occurs in two patterns. One is the worsening of treated inflammation against an antigen, the called “paradoxical reaction”, the other is the unmasking of previously sub-clinical, untreated inflammation against an antigen, so called “unmasking”. IRIS was initially recognized and has mostly been reported in HIV-infected patients treated with antiretroviral therapy (ART). IRIS usually presents as infectious diseases. It can be fatal, especially if it involves the central nerve system, so the timing to initiate ART must be decided carefully. Recently, IRIS has been reported in non-HIV-infected patients, and as non-infectious diseases. Paradoxical clinical worsening has been reported in patients with tuberculosis or pneumocystis pneumonia along with initiating treatment regardless of whether they are HIV infected or not. While the most appropriate name may not be “IRIS”, it is important to recognize this condition, and understand that steroid therapy can improve the patients' prognosis.

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11巻1号 (2019年1月)
電子版ISSN 2186-7852 印刷版ISSN 1883-4833 メディカル・サイエンス・インターナショナル