Cryptococcal fungemia and probable histoplasmosis in a patient infected with HIV. Case report

Abstract

BackgroundThose infected by human immunodeficiency virus (HIV) have a higher risk of opportunistic infections. The risk is related to the level of immunosuppression. We report a case of a young male with the unusual scenario of three opportunistic infections occurring simultaneously: Cryptococcosis, Histoplasmosis and Cryptosporidiosis. Histoplasmosis and cryptococcosis are major causes of morbimortality in immunocompromised patients due to HIV infection.Case presentationWe report the case of a patient with HIV infection with a CD4 T lymphocyte cell (CD4) count of 2 cells/mm3, who presented with 6 months of diarrhea, non-productive dry cough, nocturnal diaphoresis, fever, weight loss, and a maculopapular rash. He had a concurrent infection with three opportunistic microorganisms: fungemia by cryptococcosis, disseminated histoplasmosis confirmed by detection of the antigen in urine and chronic diarrhea by cryptosporidiosis confirmed by direct observation in feces by modified Ziehl–Neelsen stain. The patient received antifungal treatment with a satisfactory outcome.ConclusionsThere are still regions where HIV detection programs are deficient thus facilitating occurrence of HIV infection cases in advanced stages of immunosuppression. A high level of suspicion of systemic mycoses and concurrent infection by several opportunistic pathogens is required in severely immunocompromised patients.

HIV-Associated Histoplasmosis

“…Other opportunistic infections (OI's) associated with histoplasmosis-HIV coinfection have been described: pneumocystosis [81], cryptococcal infection [82], cytomegalovirus infection, Salmonella infection, candidiasis, and toxoplasmosis [75]. Sometimes, more co-infections could be hosted by the same HIV-infected person [83].…”