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Joao I, Bujdáková H, Jordao L. Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients. Antibiotics (Basel) 2020; 9:E771. [PMID: 33147819 PMCID: PMC7693372 DOI: 10.3390/antibiotics9110771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) and many fungal species (spp.) are commonly associated with opportunistic infections (OPIs) in immunocompromised individuals. Moreover, occurrence of concomitant infection by NTM (mainly spp. of Mycobacterium avium complex and Mycobacterium abscessus complex) and fungal spp. (mainly, Aspergillus fumigatus, Histoplasma capsulatum and Cryptococcus neoformans) is very challenging and is associated with poor patient prognosis. The most frequent clinical symptoms for coinfection and infection by single agents (fungi or NTM) are similar. For this reason, the accurate identification of the aetiological agent(s) is crucial to select the best treatment approach. Despite the significance of this topic it has not been sufficiently addressed in the literature. This review aims at summarizing case reports and studies on NTM and fungi coinfection during the last 20 years. In addition, it briefly characterizes OPIs and coinfection, describes key features of opportunistic pathogens (e.g., NTM and fungi) and human host predisposing conditions to OPIs onset and outcome. The review could interest a wide spectrum of audiences, including medical doctors and scientists, to improve awareness of these infections, leading to early identification in clinical settings and increasing research in the field. Improved diagnosis and availability of therapeutic options might contribute to improve the prognosis of patients' survival.
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Affiliation(s)
- Ines Joao
- National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal;
| | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 842 15 Bratislava, Slovakia
| | - Luisa Jordao
- National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisboa, Portugal;
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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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Abstract
Cough is a common symptom often confronted in the clinical setting. Time and resources attributed to cough place an undue burden on patients and the health care system. One characteristic of cough that likely contributes to this is the multifactorial nature of cough. Physicians are trained to find a single diagnosis to explain symptoms. With cough, if all factors contributing are not identified and treated together, the cough often remains unresolved. This article provides a practical approach to treatment and management of cough, emphasizing causes and potentiators.
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Affiliation(s)
- Baotran B Tran
- Division of Allergy-Immunology, Northwestern Medicine, Chicago, IL, USA
| | - Anne Marie Ditto
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, 211 East Ontario Ste. 1000, Chicago, IL 60611, USA.
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