IRIS and fungal infections: What have we learned?
Restoration of pathogen-specific immunity as a result of highly active antiretroviral therapy or reduction of immunosuppression in solid-organ transplant recipients can result in a destructive inflammatory response known as the immune reconstitution inflammatory syndrome (IRIS). Though immune reconstitution disorders can occur in the context of a number of infectious and neoplastic processes, IRIS associated with invasive mycoses, in particular crypto-coccosis, is a highly prevalent and morbid entity worldwide. Recent consensus definitions and prospective analyses of cryptococcal IRIS, with particular attention to baseline clinical features, serum and cerebrospinal fluid biomarkers, and the evolution of these over time in individual patients have provided critical insights into pathogenesis. This review focuses on the current understanding of IRIS in the context of opportunistic mycoses, with particular attention to Cryptococcus infection, and discusses the basis for this understanding, including biomarkers as clues to pathogenesis and aids in diagnosis and novel approaches to prevention and management. © 2012 Springer Science+Business Media, LLC.
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