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Concurrent Persistent Cryptococcosis and Mycobacterium avium Complex Infections in a Patient With Human

Abdulaziz U Joury1,2, Mona Alshehri3, Mustafa Alhasan4

  • 1Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA.

Ochsner Journal
|July 2, 2019
PubMed

Insights

This case report details a rare co-infection of cryptococcal meningitis and Mycobacterium avium complex (MAC) in an HIV-positive patient. The simultaneous infection prolonged antifungal therapy during the induction phase.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Mycology

Background:

  • Fungal infections, particularly fungal meningitis, present significant challenges due to chronicity, latency, and difficulty in eradication.
  • The complex interplay between fungal pathogens and the host immune system remains incompletely understood.
  • Cryptococcosis is a critical opportunistic infection in human immunodeficiency virus (HIV)-positive individuals, necessitating prompt treatment.

Observation:

  • A 28-year-old male with HIV presented with simultaneous cryptococcal meningitis and Mycobacterium avium complex (MAC) co-infection.
  • The patient underwent a 2-week induction phase of antifungal therapy with amphotericin B and flucytosine.
  • Despite initial aggressive treatment and clinical improvement, persistent signs of cryptococcal infection were noted on imaging and lumbar puncture.

Findings:

  • Concurrent cryptococcosis and MAC co-infection is exceptionally rare, even in immunocompromised populations.
  • This rare co-infection was associated with an extended induction phase of antifungal therapy for cryptococcosis.

Implications:

  • Highlights the potential for rare co-infections to complicate treatment protocols in immunocompromised patients.
  • Underscores the need for vigilant diagnostic and therapeutic approaches in managing opportunistic infections in HIV patients.
  • Suggests that co-infections may necessitate prolonged or modified treatment strategies beyond standard protocols.
Keywords:
CryptococcosisHIVMycobacterium avium complexmeningitis–cryptococcal

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