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Basso RP, Poester VR, Silveira JM, Vieira RS, Mota LDD, Klafke GB, Müller JN, Penna CP, Vianna JS, Busatto C, Silva PEAD, Ramis IB, Stevens DA, Xavier MO. Histoplasma capsulatum and Mycobacterium avium co-infection in an immunocompromised patient: Case report and literature review. Med Mycol Case Rep 2020; 28:29-32. [PMID: 32322474 PMCID: PMC7171255 DOI: 10.1016/j.mmcr.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022] Open
Abstract
We report a case of fungal and mycobacterial co-infection in an immunosuppressed patient from Southern Brazil. Histoplasmosis was diagnosed in an AIDS patient admitted to the hospital with nonspecific respiratory signs. However, 4 months post hospital discharge, the patient worsened and a co-infection with Mycobacterium avium was detected. Physicians must consider and investigate a broad spectrum of diseases which can occur as co-infections and which share the same clinical symptoms and signs in immunosuppressed patients.
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Affiliation(s)
- Rossana Patricia Basso
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil.,Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED-FURG), RS, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), Vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Brazil
| | - Vanice Rodrigues Poester
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil.,Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED-FURG), RS, Brazil
| | - Jussara Maria Silveira
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), Vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Brazil
| | - Roseli Stone Vieira
- Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), Vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Brazil
| | - Luisa Dias da Mota
- Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), Vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Brazil
| | - Gabriel Baracy Klafke
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil
| | - Jéssica Nunes Müller
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil
| | - Crislaine Padilha Penna
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil
| | - Júlia Silveira Vianna
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil
| | - Caroline Busatto
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil.,Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED-FURG), RS, Brazil
| | - Pedro Eduardo Almeida da Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil.,Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED-FURG), RS, Brazil
| | - Ivy Bastos Ramis
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil.,Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED-FURG), RS, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Div. of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Melissa Orzechowski Xavier
- Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Rio Grande do Sul, RS, Brazil.,Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED-FURG), RS, Brazil.,California Institute for Medical Research, San Jose, CA, USA.,Div. of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
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Wang ZD, Liu Q, Liu HH, Li S, Zhang L, Zhao YK, Zhu XQ. Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: a global systematic review and meta-analysis. Parasit Vectors 2018; 11:28. [PMID: 29316950 PMCID: PMC5759777 DOI: 10.1186/s13071-017-2558-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diarrhea caused by opportunistic intestinal protozoa is a common problem in HIV infection. We aimed to establish the prevalence of Cryptosporidium, misrosporidia, and Isospora in HIV-infected people using a systematic review and meta-analysis, which is central to developing public policy and clinical services. METHODS We searched PubMed, ScienceDirect, Google Scholar, Embase, Chinese Web of Knowledge, Wanfang, and Chongqing VIP databases for studies reporting Cryptosporidium, microsporidia, or Isospora infection in HIV-infected people. We extracted the numbers of people with HIV and protozoa infection, and estimated the pooled prevalence of parasite infection by a random effects model. RESULTS Our research identified 131 studies that reported Cryptosporidium, microsporidia, and Isospora infection in HIV-infected people. We estimated the pooled prevalence to be 14.0% (3283/43,218; 95% CI: 13.0-15.0%) for Cryptosporidium, 11.8% (1090/18,006; 95% CI: 10.1-13.4%) for microsporidia, and 2.5% (788/105,922; 95% CI: 2.1-2.9%) for Isospora. A low prevalence of microsporidia and Isospora infection was found in high-income countries, and a high prevalence of Cryptosporidium and Isospora infection was found in sub-Saharan Africa. We also detected a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in patients with diarrhea. Sensitivity analysis showed that three studies significantly affect the prevalence of Isospora, which was adjusted to 5.0% (469/8570; 95% CI: 4.1-5.9%) by excluding these studies. CONCLUSIONS Our findings suggest that HIV-infected people have a high prevalence of Cryptosporidium, microsporidia, and Isospora infection in low-income countries and patients with diarrhea, especially in sub-Saharan Africa, reinforcing the importance of routine surveillance for opportunistic intestinal protozoa in HIV-infected people.
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Affiliation(s)
- Ze-Dong Wang
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046 People’s Republic of China
| | - Quan Liu
- Military Veterinary Institute, Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Academy of Military Medical Sciences, Changchun, Jilin Province 130122 People’s Republic of China
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130188 People’s Republic of China
| | - Huan-Huan Liu
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130188 People’s Republic of China
| | - Shuang Li
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130188 People’s Republic of China
| | - Li Zhang
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130188 People’s Republic of China
| | - Yong-Kun Zhao
- Military Veterinary Institute, Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Academy of Military Medical Sciences, Changchun, Jilin Province 130122 People’s Republic of China
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046 People’s Republic of China
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Hu Z, Chen J, Wang J, Xiong Q, Zhong Y, Yang Y, Xu C, Wei H. Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients. PLoS One 2017; 12:e0173858. [PMID: 28301552 PMCID: PMC5354418 DOI: 10.1371/journal.pone.0173858] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background Current understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC. Methods HIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis. Results 60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0–205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were “laboratory-confirmed” cases, 48.2% were “clinically confirmed” cases and 16.1% were “clinically probable” cases. 85.7% of the pleural effusions could be “clinically confirmed” cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia. Conclusions This study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection.
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Affiliation(s)
- Zhiliang Hu
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Jun Chen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Juan Wang
- Department of Pathology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingfang Xiong
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Yandan Zhong
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Yongfeng Yang
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
| | - Chuanjun Xu
- Department of radiology, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
- * E-mail: (CX); (HW)
| | - Hongxia Wei
- Department of Infectious Disease, the Second Affiliated Hospital of Medical School of the Southeast University, Nanjing, Jiangsu, China
- * E-mail: (CX); (HW)
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Abstract
The incidence and death rates from tuberculosis (TB) have declined through concerted efforts in the diagnosis and treatment of active disease. Despite this, 9.6 million new cases and 1.1 million deaths in 2014 are unacceptably high. To decrease the rates of TB further, the huge number of persons with latent TB infection (LTBI) from whom new cases will arise has to be addressed with a sense of priority. Identifying the highest risk groups and providing effective treatment has been shown to decrease active TB. Further research to refine the predictors of reactivation and shorter effective treatments are urgently needed. Implementing intensified case finding, testing and treatment for LTBI will require continued investment in health care capacity at multiple levels.
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Affiliation(s)
- Andrew R DiNardo
- a Global and Immigrant Health , Baylor College of Medicine , Houston , TX , USA
| | - Elizabeth Guy
- b Pulmonology, Department of Internal Medicine , Baylor College of Medicine , Houston , TX , USA
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