Virology: immune reconstitution inflammatory syndrome: practice question

A Microbiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Microbiology · Virology: immune reconstitution inflammatory syndrome

Sample item

A man with HIV (CD4 count 25 cells/mm3) begins antitubercular therapy for pulmonary tuberculosis and starts antiretroviral therapy 3 weeks later. Four weeks after that, he develops fever, enlarging cervical nodes and worsening pulmonary infiltrates. Adherence is good, the sputum is now smear negative and the viral load has fallen. What is the most likely explanation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Paradoxical tuberculosis immune reconstitution inflammatory syndrome

After starting antiretroviral therapy, recovering immune function mounts an exaggerated inflammatory response against residual mycobacterial antigen, producing paradoxical worsening despite clinical and microbiological response. The viral load falls and CD4 count rises. Management is to continue both treatments, exclude drug resistance and other infections, and give corticosteroids for severe cases.

Option by option

  • A. Drug fever due to rifampicin

    Drug fever does not enlarge lymph nodes or worsen infiltrates.

  • B. Pneumocystis jirovecii pneumonia

    Pneumocystis infection would be an alternative cause, but nothing in the picture suggests a new pathogen and the timing points to immune recovery.

  • C. Treatment failure due to multidrug-resistant tuberculosis

    Drug resistance would show persistent smear positivity and would not be explained by the timing after starting antiretroviral therapy.

  • D. Paradoxical tuberculosis immune reconstitution inflammatory syndrome (correct)

    Worsening with a falling viral load and negative smear after starting antiretrovirals fits paradoxical immune reconstitution.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is D, Paradoxical tuberculosis immune reconstitution inflammatory syndrome. After starting antiretroviral therapy, recovering immune function mounts an exaggerated inflammatory response against residual mycobacterial antigen, producing paradoxical worsening despite clinical and microbiological response.

Why is "Drug fever due to rifampicin" not the answer?

Drug fever does not enlarge lymph nodes or worsen infiltrates.

Why is "Pneumocystis jirovecii pneumonia" not the answer?

Pneumocystis infection would be an alternative cause, but nothing in the picture suggests a new pathogen and the timing points to immune recovery.

Why is "Treatment failure due to multidrug-resistant tuberculosis" not the answer?

Drug resistance would show persistent smear positivity and would not be explained by the timing after starting antiretroviral therapy.

What concept does this question test?

It tests Virology: immune reconstitution inflammatory syndrome in Microbiology. The viral load falls and CD4 count rises. Management is to continue both treatments, exclude drug resistance and other infections, and give corticosteroids for severe cases.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Virology: immune reconstitution inflammatory syndrome?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.