Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has changed the focus of healthcare and become a public health challenge around the world. The coinfection of SARS-CoV-2 with other microorganisms, including fungi, can cause difficult diagnosis and a worse prognosis.
Pneumocystis jirovecii
pneumonia (PJP) is a common opportunistic infection in human immunodeficiency virus (HIV) patients. However, sometimes the diagnosis is late presented after PJP finding on chest X-ray. We report a 24-year-old man with COVID-19 and PJP. Reverse transcriptase-polymerase chain reaction showed positive for SARS-CoV-2. HIV diagnosis was late presented after PJP finding on chest X-ray examination. HIV serology was positive with an absolute CD4+ count was 16 cells/mm
3
. He was treated with remdesivir IV, methylprednisolone IV, heparin, and cefoperazone-sulbactam IV. He was discharged after being admitted for 25 days. HIV treatment was started in outpatient services. Radiological diagnostic to diagnose concurrent COVID-19 and PJP pneumonia are important, especially in the setting where microscopic examination of sputum or Bronchoalveolar Lavage Fluid (BALF) is not available, or because BAL and sputum induction are aerosol-generating procedures that potentially increase the risk of COVID-19 transmission. HIV testing in COVID-19 patients was also should be considered as part of directed screening in patients presenting with features of PJP, especially for those with unknown HIV status. The determination of an appropriate corticosteroid dose is important to treat both COVID-19 and PJP with severe clinical features. Proper diagnosis and treatment co-infections are urgently needed in this current pandemic to reduce morbidity and mortality.
Colocutaneous fistula with nephrocutaneous fistula is a rare condition. Renal replacement lipomatosis is the result of the atrophy and destruction of renal parenchyma. We report a 60-year-old male with intermittent drainage mucus and fluid from ulcer of his right lumbar region. Renal ultrasound and plain abdominal X-ray revealed a chronic parenchymal disease with stone of the right kidney. Fistulography showed a fistula tract connecting the skin and the right pelvicalyceal system and the colon. Computerized tomography demonstrated a renal calculus with a massive fatty proliferation. The patient was planned for right nephrectomy and excision of the sinus tract.
Introduction: Toxoplasma gondii is an intracellular pathogenic parasite with the majority of co-infections occurring in HIV/AIDS patients. This study assesses the head computed tomography (CT) images of cerebral toxoplasmosis in patients with HIV/AIDS.Methods: This study was a cross-sectional design using head CT images of 35 HIV/AIDS patients with suspected cerebral toxoplasmosis. Variables include lesion type, location, size, CD4 count, and therapeutic result with anti-cerebral toxoplasmosis. All data analysed descriptively.Results: From total 110, 35 patients met the inclusion criteria. 24 patients (68.6%) were male and 11 (31.4%) female, average age, was 36.1. 8 patients (22.3%) had lesions in cortical, 31 patients (88.6%) had < 1 cm lesion. Single lesions mainly calcified and found in the right centrum semiovale while multiple lesions were subcortical. A hypodense lesion with rim or nodular contrast enhancement is found in 75% of patients with CD4 > 200 in contrast to slight rim contrast enhancement and perifocal edema in patients with CD4 < 200. 20 patients (57.4%) had improved condition after anti-toxoplasmosis therapy.Conclusion: Cerebral toxoplasmosis lesions in HIV/AIDS patients have various types of imaging findings, mostly multiple, with most frequent location being cortical and diameter < 1 cm. Total recovery is achieved in the majority of patients with therapy.
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