Martinez Valérie, Bricaire François
Service des maladies infectieuses et tropicales, Groupe Hospitalier Pitié-Salpétrière, Paris (75).
Service des maladies infectieuses et tropicales, Groupe Hospitalier Pitié-Salpétrière, Paris (75).
Presse Med. 2006 Nov;35(11 Pt 2):1747-1750. doi: 10.1016/S0755-4982(06)74893-X.
Paradoxical reactions during tuberculosis are defined by exacerbation of clinical symptoms or laboratory or radiologic abnormalities during antituberculosis treatment or when an antiretroviral treatment is added to it. This phenomenon does not involve relapse of the opportunistic infection but rather a reconstitution of an abnormal immune response. The phenomenon is relatively frequent after antiretroviral treatment begins in HIV-infected patients with tuberculosis. Diagnosis, based on a group of heterogeneous clinical and/or radiologic criteria, is often difficult. Although outcome is most often spontaneously favorable, complications are possible. Treatment relies on the maintenance of specific treatment of the pathogen responsible for the opportunistic infection, the antiretroviral treatment, and possibly the addition of corticosteroid therapy.
结核病期间的矛盾反应定义为在抗结核治疗期间或在抗结核治疗基础上加用抗逆转录病毒治疗时临床症状、实验室检查或影像学异常加重。这种现象并非机会性感染复发，而是异常免疫反应的重建。在合并结核病的HIV感染患者开始抗逆转录病毒治疗后，这种现象相对常见。基于一组异质性临床和/或影像学标准进行诊断往往很困难。虽然结果大多自发好转，但仍可能出现并发症。治疗依赖于维持对引起机会性感染的病原体的特异性治疗、抗逆转录病毒治疗，可能还需加用糖皮质激素治疗。
