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Concomitant Infections of Influenza A H1N1 and Disseminated Cryptococcosis in an HIV Seropositive Patient.

Gupta A, Capoor MR, Gupta S, Sachdeva HC - J Lab Physicians (2015 Jul-Dec)

Bottom Line: Respiratory viral infections, especially influenza have a potential to form a fatal association with cryptococcosis in the setting of compromised immunity.Considering the lethality of these two infections, we report an unusual case of dual infection of pandemic influenza A H1N1 and disseminated cryptococcosis in an HIV seropositive individual.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

ABSTRACT
Respiratory viral infections, especially influenza have a potential to form a fatal association with cryptococcosis in the setting of compromised immunity. Considering the lethality of these two infections, we report an unusual case of dual infection of pandemic influenza A H1N1 and disseminated cryptococcosis in an HIV seropositive individual.

No MeSH data available.


Related in: MedlinePlus

Gram's stain smear of pleural fluid sample showing broad base budding yeasts cells and exudate
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Figure 2: Gram's stain smear of pleural fluid sample showing broad base budding yeasts cells and exudate

Mentions: A 34-year-old adult male presented to the emergency department with complaints of high-grade fever, breathlessness, and cough for 15 days. He was admitted to pandemic influenza intensive care unit. The patient was conscious, oriented to time, place and person, had tachypnea, tachycardia, pallor, and edema. The past history was significant for smoking and alcoholism. He had suffered from pulmonary tuberculosis (TB) 2 years back and had taken a full course of anti-tubercular therapy. Respiratory system examination revealed bilateral basal crepitations. Central nervous system examination showed a positive Babinski's sign. The hematological parameters, liver and kidney function tests were normal except low hemoglobin of 6%. Computed tomography of the chest revealing bilateral air space consolidation, ground-glass opacities, and bilateral parenchymal lesions suggestive of bilateral pneumonitis [Figure 1]. He was diagnosed with pandemic influenza A H1N1 by real-time polymerase chain reaction as per Centers for Disease Control and Prevention guidelines. A sputum pyogenic culture was positive for Escherichia coli, and it was sensitive to meropenem and ertapenem. Sputum for mycobacterial culture was negative. Patient's urine and blood cultures were sterile. A provisional diagnosis of pandemic influenza pneumonitis with adult respiratory distress syndrome was made, and patient's management initiated. The antibiotic therapy with ertapenem, oseltamivir and fluconazole was started. On the 7th day, patient's condition deteriorated. His arterial blood gas parameters were deranged and was put on a ventilator. Samples were sent for fungal and bacterial culture. India ink examination of cerebrospinal fluid (CSF) and pleural fluid demonstrated capsulated budding yeast cells [Figure 2]. Latex agglutination test was positive for the cryptococcal antigen. C. neoformans was isolated in fungal cultures of CSF, sputum, and pleural fluid. It was sensitive to amphotericin B, fluconazole, itraconazole, voriconazole and flucytosine. Injection amphotericin 1 mg/kg body weight was started. The patient was also declared positive for HIV by three different ELISA kits using three different antigens. CD 4 cell count was 39 cells/μL. His partner was also HIV positive, and she gave a history of contact in her spouse. On 14th day, no improvement was seen and patient developed respiratory acidosis. Despite the timely diagnosis, the patient died.


Concomitant Infections of Influenza A H1N1 and Disseminated Cryptococcosis in an HIV Seropositive Patient.

Gupta A, Capoor MR, Gupta S, Sachdeva HC - J Lab Physicians (2015 Jul-Dec)

Gram's stain smear of pleural fluid sample showing broad base budding yeasts cells and exudate
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4559629&req=5

Figure 2: Gram's stain smear of pleural fluid sample showing broad base budding yeasts cells and exudate
Mentions: A 34-year-old adult male presented to the emergency department with complaints of high-grade fever, breathlessness, and cough for 15 days. He was admitted to pandemic influenza intensive care unit. The patient was conscious, oriented to time, place and person, had tachypnea, tachycardia, pallor, and edema. The past history was significant for smoking and alcoholism. He had suffered from pulmonary tuberculosis (TB) 2 years back and had taken a full course of anti-tubercular therapy. Respiratory system examination revealed bilateral basal crepitations. Central nervous system examination showed a positive Babinski's sign. The hematological parameters, liver and kidney function tests were normal except low hemoglobin of 6%. Computed tomography of the chest revealing bilateral air space consolidation, ground-glass opacities, and bilateral parenchymal lesions suggestive of bilateral pneumonitis [Figure 1]. He was diagnosed with pandemic influenza A H1N1 by real-time polymerase chain reaction as per Centers for Disease Control and Prevention guidelines. A sputum pyogenic culture was positive for Escherichia coli, and it was sensitive to meropenem and ertapenem. Sputum for mycobacterial culture was negative. Patient's urine and blood cultures were sterile. A provisional diagnosis of pandemic influenza pneumonitis with adult respiratory distress syndrome was made, and patient's management initiated. The antibiotic therapy with ertapenem, oseltamivir and fluconazole was started. On the 7th day, patient's condition deteriorated. His arterial blood gas parameters were deranged and was put on a ventilator. Samples were sent for fungal and bacterial culture. India ink examination of cerebrospinal fluid (CSF) and pleural fluid demonstrated capsulated budding yeast cells [Figure 2]. Latex agglutination test was positive for the cryptococcal antigen. C. neoformans was isolated in fungal cultures of CSF, sputum, and pleural fluid. It was sensitive to amphotericin B, fluconazole, itraconazole, voriconazole and flucytosine. Injection amphotericin 1 mg/kg body weight was started. The patient was also declared positive for HIV by three different ELISA kits using three different antigens. CD 4 cell count was 39 cells/μL. His partner was also HIV positive, and she gave a history of contact in her spouse. On 14th day, no improvement was seen and patient developed respiratory acidosis. Despite the timely diagnosis, the patient died.

Bottom Line: Respiratory viral infections, especially influenza have a potential to form a fatal association with cryptococcosis in the setting of compromised immunity.Considering the lethality of these two infections, we report an unusual case of dual infection of pandemic influenza A H1N1 and disseminated cryptococcosis in an HIV seropositive individual.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.

ABSTRACT
Respiratory viral infections, especially influenza have a potential to form a fatal association with cryptococcosis in the setting of compromised immunity. Considering the lethality of these two infections, we report an unusual case of dual infection of pandemic influenza A H1N1 and disseminated cryptococcosis in an HIV seropositive individual.

No MeSH data available.


Related in: MedlinePlus