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Current HIV Research

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ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

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Case Report

Coexistence of Cryptococcal Fungemia and Pneumocystis jirovecii Pneumonia in an HIV-Infected Patient: A Case Report

Author(s): Tuba TATLI KIŞ*, Süleyman Yildirim, Can Biçmen, Nur Yücel and Cenk Kirakli

Volume 21, Issue 4, 2023

Published on: 24 October, 2023

Page: [259 - 263] Pages: 5

DOI: 10.2174/011570162X254084231016192302

Price: $65

Abstract

Introduction: Opportunistic infections caused by bacteria and fungi are common in human immunodeficiency virus (HIV)-infected patients. Cryptococcus neoformans and Pneumocystis jirovecii are the most common opportunistic infections in immunosuppressed individuals, but their coexistence is rare. To our knowledge, this is the first case presented in Turkey involving the coexistence of C.neoformans fungemia and P.jirovecii pneumonia.

Case Presentation: A 26-year-old male patient presented with a cachectic appearance, cough, sputum, weakness, shortness of breath, and a weight loss of 15 kg in the last three months. It was learned that the patient was diagnosed with HIV three years ago, did not go to follow-ups, and did not use the treatments. CD4 cell count was 7/mm3 (3.4%), CD8 cell count was 100 (54%) mm3, and HIV viral load was 5670 copies/mL. In thorax computed tomography (CT), increases in opacity in diffuse ground glass density in both lungs and fibroatelectasis in lower lobes were observed. With the prediagnosis of P. jiroveci pneumonia, the HIV-infected patient was given trimethoprim-- sulfamethoxazole 15 mg/kg/day intravenously (i.v.). On the 4th day of the patient's hospitalization, mutiplex PCR-based rapid syndromic Biofire (Film Array) blood culture identification 2 (BCID2) test (Biomerieux, France) was applied for rapid identification from blood culture. C. neoformans was detected in the blood culture panel. The treatment that the patient was taking with the diagnosis of C. neoformans fungemia was started at a dose of liposomal amphotericin B 5 mg/kg/- day + fluconazole 800 mg/day.

Conclusion: While the incidence of opportunistic infections has decreased with antiretroviral therapy (ART), it remains a problem in patients who are unaware of being infected with HIV or who fail ART or refuse treatment. High fungal burden, advanced age, low CD4+ cell count, and being underweight are risk factors for mortality in HIV-positive patients. Our case was a cachectic patient with a CD4 count of 7 cells/mm3. Despite the early and effective treatment, the course was fatal.

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[1]
Limper AH, Adenis A, Le T, Harrison TS. Fungal infections in HIV/AIDS. Lancet Infect Dis 2017; 17(11): e334-43.
[http://dx.doi.org/10.1016/S1473-3099(17)30303-1] [PMID: 28774701]
[2]
Brown GD, Denning DW, Gow NAR, Levitz SM, Netea MG, White TC. Hidden killers: Human fungal infections. Sci Transl Med 2012; 4(165): 165rv13.
[http://dx.doi.org/10.1126/scitranslmed.3004404] [PMID: 23253612]
[3]
Jean SS, Fang CT, Shau WY, et al. Cryptococcaemia: Clinical features and prognostic factors. QJM 2002; 95(8): 511-8.
[http://dx.doi.org/10.1093/qjmed/95.8.511] [PMID: 12145390]
[4]
Martin-Blondel G, Ysebaert L. Disseminated cryptococcosis. N Engl J Med 2014; 370(18): 1741.
[http://dx.doi.org/10.1056/NEJMicm1309435] [PMID: 24785209]
[5]
Subahi EA, Aljafar MS, Barjas HH, Abdelrazek M, Rasoul FA. Co-infection by Cryptococcus neoformans fungaemia and nontuberculous mycobacteria with Pneumocystis jiroveci pneumonia in a newly diagnosed HIV-infected patient. Clin Case Rep 2021; 9(7): e04191.
[http://dx.doi.org/10.1002/ccr3.4191]
[6]
Sarigül F, Üser U, Öztoprak N. Cryptococcus neoformans meningitis with renal involvement in an HIV-positive patient: A case report. Klimik Derg 2020; 31(2): 153-6.
[http://dx.doi.org/10.5152/kd.2018.36]
[7]
Strickland AB, Shi M. Mechanisms of fungal dissemination. Cell Mol Life Sci 2021; 78(7): 3219-38.
[http://dx.doi.org/10.1007/s00018-020-03736-z] [PMID: 33449153]
[8]
Shibata S, Kikuchi T. Pneumocystis pneumonia in HIV-1-infected patients. Respir Investig 2019; 57(3): 213-9.
[http://dx.doi.org/10.1016/j.resinv.2019.01.009] [PMID: 30824356]
[9]
Meléndez J, Reinhardt SW, O’Halloran JA, et al. Late presentation and missed opportunities for HIV diagnosis in Guatemala. AIDS Behav 2019; 23(4): 920-8.
[http://dx.doi.org/10.1007/s10461-018-2331-y] [PMID: 30426264]
[10]
Late Presentation Working Groups in EuroSIDA and COHERE. Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010–2016. BMC Infect Dis 2020; 20(1): 728.
[http://dx.doi.org/10.1186/s12879-020-05261-7] [PMID: 33028235]
[11]
Desai A, Fe A, Desai A, Ilowite J, Cunha BA, Mathew JP. A case of pneumonia caused by Pneumocystis jirovecii and cryptococcus neoformans in a patient with HTLV-1 associated adult T- cell leukemia/lymphoma: Occam’s razor blunted. Conn Med 2016; 80(2): 81-3.
[PMID: 27024978]
[12]
Gil Y, Gil YD, Markou T. The emergence of cryptococcemia in covid-19 infection: A case report. Cureus 2021; 13(11): e19761.
[http://dx.doi.org/10.7759/cureus.19761] [PMID: 34938636]
[13]
Almeida-Silva F, Damasceno LS, Serna MJB, et al. Multiple opportunistic fungal infections in an individual with severe HIV disease: A case report. Rev Iberoam Micol 2016; 33(2): 118-21.
[http://dx.doi.org/10.1016/j.riam.2015.09.001] [PMID: 26896884]
[14]
Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. Available from: https://aidsinfo.nih.gov/guidelines on 10/22/2017
[15]
Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med 2014; 370(26): 2487-98.
[http://dx.doi.org/10.1056/NEJMoa1312884] [PMID: 24963568]
[16]
Putignani L, Antonucci G, Paglia MG, et al. Cryptococcal lymphadenitis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-positive patient: A case report and review of the literature. Int J Immunopathol Pharmacol 2008; 21(3): 751-6.
[http://dx.doi.org/10.1177/039463200802100332] [PMID: 18831914]
[17]
May M, Boulle A, Phiri S, et al. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: A collaborative analysis of scale-up programmes. Lancet 2010; 376(9739): 449-57.
[http://dx.doi.org/10.1016/S0140-6736(10)60666-6] [PMID: 20638120]
[18]
de Oliveira RB, Atobe JH, Souza SA, de Castro LSDW. Epidemiology of invasive fungal infections in patients with acquired immunodeficiency syndrome at a reference hospital for infectious diseases in Brazil. Mycopathologia 2014; 178(1-2): 71-8.
[http://dx.doi.org/10.1007/s11046-014-9755-3] [PMID: 24952013]

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