HIV感染背景下中枢神经系统免疫重建炎症综合征第1部分:进展性多灶性白质脑病免疫重建炎症综合征和隐球菌免疫重建炎症综合征的概述和讨论。

PubMed ID
发表日期 2013年Jul月

原始出处 AJNR公司。美国神经放射学杂志
AJNR. American journal of neuroradiology
作者 Post  M J D  Thurnher  M M  Clifford  D B  Nath  A  Gonzalez  R G  Gupta  R K  Post  K K 

文献标题 HIV感染背景下中枢神经系统免疫重建炎症综合征第1部分:进展性多灶性白质脑病免疫重建炎症综合征和隐球菌免疫重建炎症综合征的概述和讨论。
CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome.

文献摘要 SUMMARY

虽然不常见,但在HIV相关的严重免疫抑制环境下,HAART启动后形成的CNS-IRIS的特征是对死亡或潜伏的生物体或自身抗原产生强烈的炎症反应,这是由于免疫反应增强但调节失调。虽然这种反应可以从轻微到剧烈,包括非常广泛的临床范围,但认识到这一点很重要,因为改变医疗管理可能是防止神经衰弱甚至死亡的必要条件。然而,一旦被控制住,这种炎症反应可以随着免疫功能的恢复而改善患者的预后。在与中枢神经系统虹膜相关的感染性有机体中,JC病毒和隐球菌是本综述的主题。CD8细胞在软脑膜、血管周围间隙、血管甚至实质的浸润可能是CNS-IRIS的病理特征。虽然CNS-IRIS的识别可能很困难,但是新的或进行性的临床症状的出现,尽管药物治疗和实验室数据的改善,以及神经影像学研究中出现的对比度增强、间质水肿、肿块效应和感染扩散受限,这些发现并不典型未经治疗的HIV感染者应引起对CNS-IRIS的强烈怀疑。虽然CNS-IRIS是一种排除性诊断,但神经放射科医生在提醒临床医生该综合征的可能性方面起着关键作用。


SUMMARY

While uncommon, CNS-IRIS developing after the initiation of HAART in the setting of HIV-related severe immunosuppression is characterized by an intense inflammatory reaction to dead or latent organisms or to self-antigens due to a heightened but dysregulated immune response. While this reaction can range from mild to fulminating, encompassing a very wide clinical spectrum, it is important to recognize because changes in medical management may be necessary to prevent neurologic decline and even death. Once contained, however, this inflammatory response can be associated with improved patient outcome as immune function is restored. Among the infectious organisms that are most commonly associated with CNS-IRIS are the JC virus and Cryptococcus organisms, which will be the subject of this review. CD8 cell infiltration in the leptomeninges, perivascular spaces, blood vessels, and even parenchyma seems to be the pathologic hallmark of CNS-IRIS. While recognition of CNS-IRIS may be difficult, the onset of new or progressive clinical symptoms, despite medical therapy and despite improved laboratory data, and the appearance on neuroimaging studies of contrast enhancement, interstitial edema, mass effect, and restricted diffusion in infections not typically characterized by these findings in the untreated HIV-infected patient should raise the strong suspicion for CNS-IRIS. While CNS-IRIS is a diagnosis of exclusion, the neuroradiologist can play a critical role in alerting the clinician to the possibility of this syndrome.


获取全文 10.3174/ajnr.A3183