Cryptococcosis and tuberculosis co-infection at a university hospital in Taiwan, 1993-2006
Journal
Infection
Journal Volume
38
Journal Issue
5
Pages
373-379
Date Issued
2010
Author(s)
Abstract
Background: The human immunodeficiency virus (HIV) epidemic and increasing use of immunosuppressive agents have increased the prevalence of both cryptococcosis and tuberculosis (TB). However, the status of co-infection with both pathogens remains unknown. Methods: This study retrospectively reviewed patient records of cryptococcosis and TB co-infection from 1993 to 2006. The temporal sequence of co-infection was defined as either concurrent or sequential. Data collected included patient demographics, HIV status, co-morbidities, clinical manifestations, treatment strategies, and outcome at 1-year follow-up. Results: There were 23 patients with cryptococcosis and TB co-infection, representing 5.4% of cryptococcosis or 0.6% of TB cases. Eleven (48%) patients were HIV-infected, and no underlying disease or immunocompromised state could be identified in six (26%) patients. Twelve (52%) patients presented with concurrent infection, but diagnosis of co-infection could be achieved simultaneously in only three (13%). Constitutional symptoms, particularly fever and weight loss, were the most common presenting symptoms, developing in more than two-thirds of the patients. The majority (83%) of the patients made a good recovery following dual antifungal and anti-TB therapy. There were three mortalities at the 1-year follow-up, which might be attributable to a delay in diagnosis and treatment of co-infection. The outcomes of HIV-infected and non-HIV-infected patients were not significantly different. Conclusions: Cryptococcosis and TB co-infection, although rare, develops in both immunocompromised and healthy individuals. Early diagnosis and treatment may improve patient prognosis. There should be a high index of suspicion in order to achieve a timely diagnosis in a TB endemic area. ? 2010 Urban & Vogel.
SDGs
Other Subjects
amphotericin B; antifungal agent; ethambutol; fluconazole; flucytosine; isoniazid; pyrazinamide; rifabutin; rifampicin; tuberculostatic agent; adult; aged; article; clinical article; clinical feature; comorbidity; controlled study; delayed diagnosis; demography; female; fever; follow up; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; human tissue; immunocompromised patient; lung tuberculosis; male; medical record; mixed infection; mortality; pulmonary cryptococcosis; retrospective study; Taiwan; treatment outcome; university hospital; weight reduction; Adult; Aged; Anti-Infective Agents; Cryptococcosis; Cryptococcus neoformans; Female; HIV Infections; Hospitals, University; Humans; Male; Middle Aged; Retrospective Studies; Taiwan; Tuberculosis
Type
journal article