Paradoxical Reactions in Tuberculosis Treatment: Mechanisms, Diagnosis and Approach

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dc.contributor.authorBuyuktuna, Seyit Ali
dc.contributor.authorKurtaran, Behice
dc.contributor.authorOzsahin, Sefa Levent
dc.contributor.authorSenol, Gunes
dc.contributor.authorKilic, Aysegul Ulu
dc.contributor.authorTasbakan, Meltem
dc.date.accessioned2025-03-20T09:50:26Z
dc.date.available2025-03-20T09:50:26Z
dc.date.issued2024
dc.departmentİzmir Bakırçay Üniversitesi
dc.description.abstractParadoxical reactions (PR) refer to the worsening of clinical manifestations of tuberculosis (TB) after the initiation of TB treatment, particularly occurring during the recovery of immune function in immunocompromised individuals. This syndrome is also known as immune reconstitution inflammatory syndrome and is more common in human immunodeficiency virus (HIV)-infected individuals after the initiation of antiretroviral therapy (ART). Although the mechanisms of PR are not fully understood, excessive inflammatory responses triggered by increased antigen load and rapid immune response are considered the main cause. This is associated with a strong T-cell response to antigens of Mycobacterium tuberculosis. Paradoxical reactions in HIV-positive individuals after ART initiation is characterized by a sudden and intense activation of TB-fighting immune cells. Symptoms of PR include fever, lymphadenopathy, pulmonary infiltrates, and enlargement of existing TB lesions. A major diagnostic challenge is the exclusion of TB treatment-resistant mycobacterial infections or other infections. Management of PR mainly involves the continuation of TB and HIV treatment. Anti-inflammatory drugs, such as corticosteroids, can be used in severe PR cases. By reducing inflammation, corticosteroids can relieve the symptoms of the disease and improve the quality of life. However, the use of these drugs should be carefully monitored and side effects should be considered. Enhancing our understanding of the mechanisms behind paradoxical reactions and developing effective management strategies could significantly advance the fight against TB and HIV. This review aims to explore the mechanisms, diagnosis, and management strategies of paradoxical reactions in tuberculosis treatment.
dc.identifier.doi10.5578/flora.2024031164
dc.identifier.endpage334
dc.identifier.issn1300-932X
dc.identifier.issn2602-2842
dc.identifier.issue3
dc.identifier.scopusqualityN/A
dc.identifier.startpage325
dc.identifier.trdizinid1262947
dc.identifier.urihttps://doi.org/10.5578/flora.2024031164
dc.identifier.urihttps://search.trdizin.gov.tr/tr/yayin/detay/1262947
dc.identifier.urihttps://hdl.handle.net/20.500.14034/2185
dc.identifier.volume29
dc.identifier.wosWOS:001320680400002
dc.identifier.wosqualityN/A
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakTR-Dizin
dc.language.isotr
dc.publisherBilimsel Tip Yayinevi
dc.relation.ispartofFlora Infeksiyon Hastaliklari Ve Klinik Mikrobiyoloji Dergisi
dc.relation.publicationcategoryDiğer
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250319
dc.subjectParadoxical reaction
dc.subjectimmune reconstitution inflammatory syndrome
dc.subjectantiretroviral therapy
dc.subjectcorticosteroid therapy
dc.subjectMycobacterium tuberculosis
dc.titleParadoxical Reactions in Tuberculosis Treatment: Mechanisms, Diagnosis and Approach
dc.typeReview

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