Immune reconstitution inflammatory syndrome in non human immunodeficiency viruses children on anti tubercular treatment

Archana V., Shafath Ahamed M., Sundari S.


The term IRIS is almost solely used in human immunodeficiency virus seropositive patients who initiated anti-retroviral therapy (ART), the term paradoxical reaction is generally used to describe a clinical worsening of tuberculosis disease after the initiation of antituberculosis treatment. Distinguishing this paradoxical reaction (PR) from disease progression or treatment failure is an important issue in CNS tuberculosis management. Thus, one must keep a watch for neurological deterioration in a child with Central nervous system tuberculosis (CNS TB). We are presenting a case of a non-Human immunodeficiency virus (HIV) child who developed TB-IRIS while on anti-tubercular drugs, who subsequently responded to steroids along with continuation of antitubercular treatment (ATT).


Anti retro viral therapy, Antitubercular treatment, Central nervous system tuberculosis Immune reconstitution Inflammatory syndrome, Human immunodeficiency virus, Paradoxical reactions

Full Text:



Meintjes G, Lawn SD, Scano F, Maartens G, French MA, Worodria W, et al. Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings. Lancet Infect Dis. 2008 Aug 1;8(8):516-23.

Burman WJ, Jones BE. Treatment of HIV-related tuberculosis in the era of effective antiretroviral therapy. Am J Respir Crit Care Med. 2001 Jul 1;164(1):7-12.

Burman W, Weis S, Vernon A, Khan A, Benator D, Jones B, Silva C, et al. Frequency, severity and duration of immune reconstitution events in HIV-related tuberculosis. Inter J Tuberculosis Lung Dis. 2007 Dec 1;11(12):1282-9.

Pepper DJ, Marais S, Maartens G, Rebe K, Chelsea, Meintjes G. Neurologic Manifestations Of Paradoxical Tuberculosis- Associated Immune Reconstitution Inflammatory Syndrome. Clin Infect Dis. 2009;48(11):e96-e107.

Pepper DJ, Marais S, Maartens G, Rebe K, Morroni C, Rangaka MX, et al. Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clini Infect Dis. 2009 Jun 1;48(11):e96-107.

Michailidis C, Pozniak AL, Mandalia S, Basnayake S, Nelson MR, Gazzard BG . Clinical characteristics of IRIS syndrome in patients with HIV and tuberculosis. Antiviral Therapy. 2005;10(3):417-22.

Elizabeth KE, Jubin K. Immune reconstitution inflammatory syndrome in CNS tuberculosis. Indian pediatrics. 2014 Aug;51(8):668-70.

Sun HY, Singh N. Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients. Curr Opinion Infect Dis. 2009 Aug 1;22(4):394-402.

Bourgarita A, Carcelaina G, Martineza V, Lascoux C, Delcey V, Gicquel B, et al. Explosion of tuberculin-specific Th1-responses induces immune restoration syndrome in tuberculosis and HIV co-infected patients. AIDS. 2006 Jan 9;20(2):F1-7.

Das A, Das SK, Mandal A, Halder AK. Cerebral tuberculoma as a manifestation of paradoxical reaction in patients with pulmonary and extrapulmonary tuberculosis. J Neurosci Rural Pract. 2012 Sep-Dec;3(3):350-4.

Meintjes G, Rangaka MX, Maartens G, Rebe K, Morroni C, Pepper DJ, et al. Novel relationship between tuberculosis immune reconstitution inflammatory syndrome and antitubercular drug resistance. Clin Infect Dis. 2009;48(5):667-76.

Orikiiriza J, Bakeera-Kitaka S, Musiime V, Mworozi EA, Mugyenyi P, Boulware DR. The clinical pattern, prevalence, and factors associated with immune reconstitution inflammatory syndrome in Ugandan children. AIDS (London, England). 2010 Aug 24;24(13):2009-17.

Sharma SK, Soneja M. HIV and immune reconstitution inflammatory syndrome (IRIS). Ind J Med Res. 2011 Dec;134(6):866.

Das KK, Jaiswal S, Shukla M, Srivastava AK, Behari S, Kumar R. Concurrent cerebellar and cervical intramedullary tuberculoma: paradoxical response on antitubercular chemotherapy and need for surgery. J Pediatr Neurosci. 2014;9(2):162-5.