Surviving a Triple Coinfection in an HIV Patient: Tuberculosis Histoplasmosis and SARS-CoV-2: Case Report
DOI:
https://doi.org/10.5195/ijms.2023.2324Keywords:
AIDS, Human Immunodeficiency Virus, Mycobacterium Tuberculosis Infection, Histoplasma Infection, Case StudyAbstract
BACKGROUND: Antiretroviral therapy has become the key to global control of the HIV/AIDS pandemic. The human immunodeficiency virus (HIV) is a retrovirus that attacks CD4+ T lymphocytes. AIDS is defined by a CD4+ count of less than 200 cells/mm³, as well as the appearance of opportunistic infections, which are the main cause of death in these patients. The most common types of co-infections are Mycobacterium tuberculosis, hepatitis C virus, Cryptococcus neoformans, Plasmodium falciparum, and hepatitis B virus. The incidence of certain opportunistic infections will continue to be a problem, especially in developing countries where access to antiretroviral therapy remains limited.
THE CASE: A 27-year-old male patient from Juticalpa, Olancho, with a history of HIV/AIDS C3 diagnosed on January 23, 2022, with a CD4+ lymphocyte count of 115 cells/microliters and a viral load of 10,000 copies/ml, goes to his health center from his department with a history of fever, intermittent type, quantified at 40 Celsius, predominantly nocturnal, attenuated with acetaminophen, without exacerbations. Among its accompanying symptoms, general malaise and fatigue, he received treatment of which the patient is unaware. Five days after his last visit, the patient returned in poor hemodynamic condition, dehydrated, with persistent fevers of 40 Celsius and respiratory difficulty, for which fluid therapy and oxygen were started. Antigen for SARS-COV-2 is requested with a positive result, for which the patient is transferred to Tegucigalpa to the Instituto Nacional Cardiopulmonar del Torax a third level hospital. Upon admission to our hospital, hemodynamically unstable, Glasgow 14/15, it was decided to perform GENXPERT, sputum and antigen for histoplasmosis and tuberculosis, which were both positive. It was decided to transfer the patient to the intensive care unit, where he received treatment with isoniazid 300 mg orally, rifampicin 600 mg orally, ethambutol 1200 mg Monday, Wednesday and Friday, and pyridoxine 50 mg orally. Likewise, liposomal amphotericin B 280 mg was administered. Twenty days later, the patient was stable after extubating. He was transferred to a respiratory isolation room to receive treatment for COVID-19 and pulmonary tuberculosis.
CONCLUSION: Co-infections between HIV and COVID-19 and tuberculosis with COVID-19 are currently poorly known. To date, only six cases of triple co-infections in HIV patients have been reported worldwide in Panama, the United States, Brazil and Cameroon. Due to the great clinical similarity, an in-depth differential diagnosis should be made between COVID-19 and tuberculosis. Timely diagnosis and treatment improve patient survival rates.
Metrics
References
Ngouanom Kuate MP, Bongomin F, Ndip RN. SARS‐CoV ‐2, HIV , and Mycobacterium tuberculosis triple co‐infection . Clin Case Reports. 2022;10(7):7–10.
Rivas N, Espinoza M, Loban A, Luque O, Jurado J, Henry-Hurtado N, et al. Case report: COVID-19 recovery from triple infection with mycobacterium tuberculosis, HIV, and SARS-CoV-2. Am J Trop Med Hyg. 2020;103(4):1597–9.
Tolossa T, Tsegaye R, Shiferaw S, Wakuma B, Ayala D, Bekele B, et al. Survival from a triple co-infection of covid-19, hiv, and tuberculosis: A case report. Int Med Case Rep J. 2021;14:611–5.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2023 Julián Martínez, Wendy Moncada, Fabiola Cordon
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
