Background: The HAART regimens changed the course of HIV infection, first leading to a drop of opportunism related to a severe immunodeficiency, including visceral candidiasis-cryptococcosis. However, the incidence of the so-called AIDS presenters is increasing during HAART since patients (p) who are unaware of or neglect HIV cannot take advantage from HAART. Methods: Two rare cases of concurrent visceral Candida-Cryptococcus co-infection occurred in p with a undiagnosed HIV disease are presented. Results: Two p who were unaware of HIV disease, were referred with a far compromised clinical situation, including prolonged fever, dysphagia, pancytopenia and weight loss, Pneumocystis carinii- Mycobacterium kansasii-Staphylococcus aureus pneumonia in the first p, and persisting headache in the second p. A candidiasis was confirmed by esophageal biopsy in both cases, while the first p also had positive Candida albicans blood cultures. Cryptococcosis was the result of fungemia in the first p, and meningeal localization in the second one, whose CSF proved positive at culture-antigen search. The severe immunodeficiency was expressed by a CD4+ lymphocyte count of 44 and 13 cells/μL respectively. After the diagnosis of concomitant dual Candida-Cryptococcus infection, fluconazole, and concurrent AmBisome in the first p, were administered, leading to mycological and clinical cure. No relapses of yeast opportunism occurred during the 16-48-mo follow-up, while immune reconstitution took place thanks to HAART. Conclusions: Multiple, concomitant-subsequent AIDS-defining illnesses were anecdotally described, but the concurrent detection of two different visceral and AIDS-related yeast diseases has no equivalents until now. Preventive-educational efforts are needed for each population target, since many p are at risk of suffering from a missed-delayed HIV recognition, and have an increased risk of advanced, life-threatening HIV disease including multiple AIDS-related disorders.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)