Understanding Pathogenesis and Care Challenges of Immune Reconstitution Inflammatory Syndrome in Fungal Infections

Sarah Dellière (1, 2) , Romain Guery (1, 2) , Sophie Candon (3) , Blandine Rammaert (4) , Claire Aguilar (1, 2) , Fanny Lanternier (5, 1, 2) , Lucienne Chatenoud (3) , Olivier Lortholary (2, 1, 5)

1 Centre d'infectiologie Necker-Pasteur [CHU Necker]
2 IMAGINE - U1163 - Imagine - Institut des maladies génétiques
3 INEM - UM 111 (UMR 8253 / U1151) - Institut Necker Enfants-Malades
4 PHAR [Poitiers] - Pharmacologie des anti-infectieux
5 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals

Immune deficiency of diverse etiology, including human immunodeficiency virus (HIV), antineoplastic agents, immunosuppressive agents used in solid organ recipients, immunomodulatory therapy, and other biologics, all promote invasive fungal infections. Subsequent voluntary or unintended immune recovery may induce an exaggerated inflammatory response defining immune reconstitution inflammatory syndrome (IRIS), which causes significant mortality and morbidity. Fungal-associated IRIS raises several diagnostic and management issues. Mostly studied with Cryptococcus, it has also been described with other major fungi implicated in human invasive fungal infections, such as Pneumocystis, Aspergillus, Candida, and Histoplasma. Furthermore, the understanding of IRIS pathogenesis remains in its infancy. This review summarizes current knowledge regarding the clinical characteristics of IRIS depending on fungal species and existing strategies to predict, prevent, and treat IRIS in this patient population, and tries to propose a common immunological background to fungal IRIS

Mots clés: fungal immunity; immune reconstitution inflammatory syndrome; invasive fungal infections; mycoses

Domaines: Maladies infectieuses

Sarah Dellière, Romain Guery, Sophie Candon, Blandine Rammaert, Claire Aguilar, et al.. Understanding Pathogenesis and Care Challenges of Immune Reconstitution Inflammatory Syndrome in Fungal Infections. Journal of Fungi, 2018, 4 (4), pp.E139. ⟨10.3390/jof4040139⟩. ⟨hal-02376352⟩