Mycobacterium tuberculosis infection is frequently found in patients infected with human immunodeficiency virus and commonly involves meningeal infection. Such patients can develop potentially lethal complications arising from the excessive cytokine production that can ensue after the initiation of antiretroviral therapy (ART), a scenario known as 'immune-reconstitution inflammatory syndrome' (IRIS). In the Journal of Infectious Diseases, Marais et al. monitor patients infected with human immunodeficiency virus who have M. tuberculosis meningitis (TBM), before and after they receive ART. At time of diagnosis, those patients who developed TBM–IRIS have higher neutrophil counts in their cerebrospinal fluid (CSF) and higher expression of neutrophil effector molecules in both blood and CSF than do those patients with TBM who did not develop IRIS after ART. Transcripts associated with NLRP3 inflammasomes increase over time in those patients who developed TBM-IRIS. These findings suggest that innate immunity involving neutrophil and inflammasome activation in the CSF contribute to the complications of TBM–IRIS.

J. Infect. Dis. (8 December 2016) http://dx.doi.org/10.1093/infdis/jiw561