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Leprosy and AIDS: two cases of increasing inflammatory reactions at the start of highly active antiretroviral therapy

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Abstract

Reported here are the cases of two HIV-positive patients with skin lesions suggestive of leprosy, based on clinical and pathological analysis, which worsened during the few weeks following initiation of highly active antiretroviral therapy. The lesions improved after a few weeks of multidrug therapy for leprosy. Mycobacterium leprae was confirmed by polymerase chain reaction analysis of blood in case 1 and of a biopsy sample in case 2. Neither Mycobacterium avium complex nucleic acid, which is usually associated with immune restoration syndrome, nor mycobacterial cutaneous manifestations were detected in either case.

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References

  1. Landay AL, Bettendorf D, Chan E, Spritzler J, Schmitz JL, Bucy RP, Gonzalez CJ, Schnizlein-Bick CT, Evans T, Squires KE, Phair JP (2002) Evidence of immune reconstitution in antiretroviral drug-experienced patients with advanced HIV disease. AIDS Res Hum Retroviruses 18:95–102

    Article  PubMed  Google Scholar 

  2. Bucy RP, Hockett RD, Derdeyn CA, Saag MS, Squires K, Sillers M, Mitsuyasu RT, Kilby JM (1999) Initial increase in blood CD4(+) lymphocytes after HIV antiretroviral therapy reflects redistribution from lymphoid tissues. J Clin Invest 103:1391–1398

    CAS  PubMed  Google Scholar 

  3. DeSimone JA, Pomerantz RJ, Babinchak TJ (2000) Inflammatory reactions in HIV-1-infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med 133:447–454

    PubMed  Google Scholar 

  4. Robinson MR, Reed G, Csaky KG, Polis MA, Whitcup SM (2000) Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy. Am J Ophthalmol 130:49–56

    Article  CAS  PubMed  Google Scholar 

  5. Hassel M, French MA (2001) Mycobacterium avium infection and immune restoration disease after highly antiretroviral therapy in patient with HIV and normal CD4 counts. Eur J Clin Microbiol Infect Dis 20:889–891

    Article  PubMed  Google Scholar 

  6. Foudraine NA, Hovenkamp E, Notermans DW, Meenhorst PL, Klein MR, Lange JM, Miedema F, Reiss P (1999) Immunopathology as a result of highly active antiretroviral therapy in HIV-1-infected patients. AIDS 13:177–184

    Article  CAS  PubMed  Google Scholar 

  7. Zamir E, Hudson H, Ober RR, Kumar SK, Wang RC, Read RW, Rao NA (2002) Massive mycobacterial choroiditis during highly active antiretroviral therapy: another immune-recovery uveitis? Ophthalmology 109:2144–2148

    Article  PubMed  Google Scholar 

  8. Bottieau E, Noe A, Florence E, Ostyn B, Colebunders R (2002) Development of multiple abscesses in an HIV/TB co-infected patient after initiation of antituberculous and highly active antiretroviral therapy. Acta Clin Belg 57:219–222

    CAS  PubMed  Google Scholar 

  9. Bartralot R, Pujol RM, Garcia-Patos V, Sitjas D, Martin-Casabona N, Coll P, Alomar A, Castells A (2000) Cutaneous infections due to nontuberculous mycobacteria: histopathological review of 28 cases. Comparative study between lesions observed in immunosuppressed patients and normal hosts. J Cutan Pathol 27:124–129

    Article  CAS  PubMed  Google Scholar 

  10. Telenti A, Marchesi F, Balz M, Bally F, Bottger EC, Bodmer T (1993) Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol 31:175–178

    CAS  PubMed  Google Scholar 

  11. Santos AR, Balassiano V, Oliveira ML, Pereira MA, Santos PB, Degrave WM, Suffys PN (2001) Detection of Mycobacterium leprae DNA by polymerase chain reaction in the blood of individuals, eight years after completion of anti-leprosy therapy. Mem Inst Oswaldo Cruz 96:1129–1133

    CAS  PubMed  Google Scholar 

  12. Devallois A, Picardeau M, Goh KS, Sola C, Vincent V, Rastogi N (1996) Comparative evaluation of PCR and commercial DNA probes for detection and identification to species level of Mycobacterium avium and Mycobacterium intracellulare. Clin Microbiol 34:2756–2759

    CAS  Google Scholar 

  13. da Silva Rocha A, Werneck Barreto AM, Dias Campos CE, Villas-Boas da Silva M, Fonseca L, Saad MH, Degrave WM, Suffys PN (2002) Novel allelic variants of Mycobacteria isolated in Brazil as determined by PCR-restriction enzyme analysis of hsp65. J Clin Microbiol 40:4191–4196

    Google Scholar 

  14. Freerksen E, Alvarenga AE, Leguizamon O, de Morra MV, von Ballestrem W, Reyes LA (1991) Short-term chemotherapy of leprosy using the combination rifampicin+cotrimoxazole+isoniazid. Med Klin 86:441–448

    CAS  PubMed  Google Scholar 

  15. Leiber DL, Verhagen AR (1973) Assessment of the bacteriological effect of combined treatment with rifadin, sulfamethoxypyrazine, and isoniazide in lepromatous leprosy. Z Tropenmed Parasitol 24:32–35

    CAS  Google Scholar 

  16. Inderlied CB, Salfinger M (1999) Antimycobacterial agents and susceptibility tests. In: Murray PM, Baron EJ, Pfaller MA, Tenover FC, Yolken RH (eds) Manual of clinical microbiology. American Society for Microbiology, Washington, DC, pp 1601–1623

  17. Sharma RK, Katoch K, Sharma VD, Shivannavar CT, Natarajan M, Katoch VM (1995) Isolation and characterization of cultivable mycobacteria from leprosy skin. Indian J Lepr 67:321–328

    CAS  PubMed  Google Scholar 

  18. del Giudice P, Durant J, Counillon E, Mondain V, Bernard E, Roger PM, Dellamonica P (1999) Mycobacterial cutaneous manifestations: a new sign of immune restoration syndrome in patients with acquired immunodeficiency syndrome. Arch Dermatol 135:1129–1130

    Article  PubMed  Google Scholar 

  19. de Magalhaes VD, de Melo Azevedo Fda P, Pasternak J, Valle Martino MD (2002) Reliability of hsp65-RFLP analysis for identification of Mycobacterium species in cultured strains and clinical specimens. J Microbiol Methods 49:295–300

    Article  PubMed  Google Scholar 

  20. Converse PJ, Bjune G (1986) Natural killer (NK) cell activity and reversal reaction in leprosy. Int J Lepr Other Mycobact Dis 54:503–509

    CAS  PubMed  Google Scholar 

  21. Ahmed AA, Nordlind K, Schultzberg M, Liden S (1994) Interleukin-1 alpha- and beta-, interleukin-6- and tumour necrosis factor-alpha-like immunoreactivities in chronic granulomatous skin conditions. Acta Derm Venereol 74:435–440

    CAS  PubMed  Google Scholar 

  22. Riedel DD, Kaufmann SH (2000) Differential tolerance induction by lipoarabinomannan and lipopolysaccharide in human macrophages. Microbes Infect 2:463–471

    Article  CAS  PubMed  Google Scholar 

  23. Beltan E, Horgen L, Rastogi N (2000) Secretion of cytokines by human macrophages upon infection by pathogenic and non-pathogenic mycobacteria. Microb Pathog 28:313–318

    Article  CAS  PubMed  Google Scholar 

  24. Ghassemi M, Asadi FK, Andersen BR, Novak RM (2000) Mycobacterium avium induces HIV upregulation through mechanisms independent of cytokine induction. AIDS Res Hum Retroviruses 16:435–440

    Article  CAS  PubMed  Google Scholar 

  25. Manning AM, Rao A (1999) Agents targeting transcription factors. In: Gallin JI, Snyderman R (eds) Inflammation: basic principles and correlates. Lippincott Williams & Wilkins, Philadelphia, pp 1159–1176

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Pignataro, P., da Silva Rocha, A., Nery, J.A.C. et al. Leprosy and AIDS: two cases of increasing inflammatory reactions at the start of highly active antiretroviral therapy. Eur J Clin Microbiol Infect Dis 23, 408–411 (2004). https://doi.org/10.1007/s10096-004-1131-7

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