To determine the occurrence and natural fate of Immune reconstitution inflammatory syndrome(IRIS) in Human immunodeficiency virus(HIV)negative patients of extra pulmonary tuberculosis(EPTB)

Abstract

Objective: Immune reconstitution inflammatory syndrome(IRIS)/Paradoxical reaction(PR) often poses diagnostic dilemma to the clinician and is sometimes confused with drug resistance. The objectives of this study were to determine the occurence and natural fate of IRIS/PR in patients of HIV negative EPTB. Material and Methods: A single center prospective observational study was conducted at King George9s Medical University, Lucknow, India over a period of 18 months (June2016-December 2017) and HIV negative patients of EPTB who were on anti-tubercular treatment(ATT) were followed and observed for various PR which resulted due to immune reconstitution phenomenon. Results: 324 subjects suffering from EPTB and were on treatment were recruited for the study.56(17.3%) patients reported with paradoxical reactions. Most common paradoxical reaction was appearance of new lymph nodes seen in 34 patients(60.7%) followed by enlargement of existing lymph nodes/cold abscess which was seen in 15(26.7%) patients, paradoxical reaction in the form of pleural effusion was observed in 7 patients(12.5%), involvement of pericardium was observed in 1 patient(1.78%). Most of the IRIS manifestations occurred during the first quarter of ATT(95%) Conclusion: IRIS was observed frequently(17.3%) in patients of extra pulmonary tuberculosis however the manifestations resolved during the course of treatment in most of the patients i.e 42(75%) without any intervention except that the treatment was prolonged,14 patients(25%)however required some form of treatment like antigravity aspiration, thoracentesis and use of oral corticosteroid.