Pulmonary Kaposi sarcoma and disseminated Mycobacterium genavense infection in an HIV-infected patient

The potential impacts of early secreted antigenic target of 6 kDa of Mycobacterium tuberculosis on KSHV-infected cells

Kaposi's sarcoma-associated herpesvirus (KSHV) causes several human cancers, including Kaposi's sarcoma (KS) and primary effusion lymphoma, which are mostly seen in immunocompromised patients, such as human immunodefeciency virus (HIV)+ individuals. Tuberculosis (TB), caused by the bacterial pathogen Mycobacterium tuberculosis (Mtb), remains one of the deadliest infectious diseases in the world. The risk of developing TB is dramatically higher in people living with HIV than among those without HIV infection. Case reports link cutaneous or pulmonary KS in HIV+ patients with mycobacterial co-infections, however, impacts of Mtb infection or its products on KSHV-infected cells are not known. We report here that ESAT-6, a secreted Mtb virulence factor, induces viral reactivation from KSHV-infected cells. KSHV-infected pulmonary endothelial cells were resistant to ESAT-6 induced inhibition of cell growth. Our data demonstrate that Mtb virulence factors influence the biology of KSHV-infected cells, highlighting the need to study the interactions between these two pathogens commonly found in people living with HIV.

Disseminated infection by Mycobacterium genavense in an HIV-1 infected patient

•

Mycobacterium genavenseinfection, a non-tuberculous mycobacteria, should be considered in immunosuppressed patients.

•

Disseminated infection by Mycobacterium genavense is a clinical and microbiological diagnostic challenge.

•

There are no standardized treatment guidelines for Mycobacterium genavense, but schemes with clarithromycin are favoured.

Opportunistic infections are an important cause of death and morbidity among HIV infected patients. Disseminated infections by nontuberculous mycobacteria are a diagnostic to consider among these patients with a high level of immunosuppression.

A 64 year old Caucasian man, born in Angola, living in Portugal since 1975, presented in the emergency room with generalized malaise, weight loss, vesperal temperatures of around 37.5 °C with night sweats for two months, and epigastric abdominal pain with liquid stools in the 2 previous weeks. Laboratory study revealed a previously undiagnosed HIV-1 infection with 42 Lymphocytes CD4+/uL and viremia of 61,249 copies/mL. The abdominal-pelvic CT scan showed multiple necrotic ganglia in the mesenterium and mesenteric vases, which were biopsied revealing positive PCR for a nontuberculous mycobacteria; duodenal biopsies showed similar results. The bone marrow blood culture yeald the growth of Mycobacterium genavense. Antimicobacterial treatment was started and after six months he showed imagiological deterioration and the antibiogram revealed resistance to all antimycobacterial agents. The therapeutic scheme was empirically changed and the patient kept under vigilance with chronic therapy.

This rare clinical case is both a diagnostic and therapeutic challenge.

An unusual case of abdominal mycobacterial infection: Case report and literature review

This article presents a case of an HIV-infected paediatric patient with an unusual Mycobacterium genavense infection with predominantly abdominal organ involvement.