Introduction: Although most cases of coccidioidomycosis are subclinical or self-limited respiratory disease, 1% lead to extrathoracic dissemination and become fatal, especially in patients with an associated immunodeficiency. Up to 30%–50% of patients with defects in cell-mediated immunity, those with AIDS and recipients of solid-organ transplants, may develop disseminated coccidioidomycosis (DC). Within the primary immunodeficiencies, an uncommon group is caused by C-terminal NFKB2 pathogenic variants. Materials and Methods: We performed a literature search of core databases. Written informed consent for the study and for publication was obtained. Case Presentation: A 7-year-old Mexican girl, eldest of 3 sisters, no relevant family history, and a history of recurrent upper respiratory infections and alopecia totalis was admitted with DC involving pulmonary, soft tissue, skin, bone and joint compromise. The immunodeficiency assessment showed low IgM and NK cells. We found an NFKB2 de novo heterozygous nonsense mutation of c.2611C>T (p.Gln871*). She was treated with liposomal amphotericin B and itraconazole with surgical debridement. The clinical phenotype of this primary immunodeficiency is characterized by antibody deficiency and associated broncho-pulmonary predisposition to infection, but moreover also opportunistic infections and autoimmunity, most recognizable alopecia and adrenocorticotropic hormone-deficiency. After 1 year of her discharge, she continues under surveillance with antifungal therapy with itraconazole and replacement intravenous immunoglobulin until today Conclusion: This is the first case report of DC in a patient with an NFKB2 pathogenic variant and it illustrates the importance of screening for primary immunodeficiencies in patients with disseminated fungal infections.

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Introduction: People living with human immunodeficiency virus (PLHIV) may suffer more severe symptoms of coronavirus disease 2019 (COVID-19) due to their immunocompromised status, even if they are undetectable. Human immunodeficiency virus (HIV) infection has been reported as an independent factor associated with higher mortality in patients with COVID-19. The present study aims to describe the clinical characteristics of PLHIV and COVID-19 in one center in Mexico. Methodology: We conducted an observational retrospective monocentric cohort study of PLHIV diagnosed with COVID-19 between 1 March 2020 and 30 April 2021. SARS-CoV-2 was detected by polymerase chain reaction (PCR) of a nasopharyngeal swab sample, clinical features, and epidemiological characteristics. Results: We identified 55 PLHIV with COVID-19. The median age was 36 years (IQR 25–41.5 years), and 54 patients were men. The median duration of HIV-1 infection was 4.3 years (Interquartile range, IQR 2.6–7.2 years), and 100% were on antiretroviral therapy (ART). The last HIV-1 RNA viral load analysis of the patients was 52/55 (94.5%) indicating that they were in virological suppression. The median CD4+ T-cell count was 734/mm3 (IQR 541.5-921/mm3). The most frequent pre-existing comorbidities found were obesity (21.8%), hypertension (7.2%), and diabetes (5.4%). Only one death was reported (1.8%). Conclusions: It has been reported that COVID-19/HIV/AIDS co-infection has a higher risk of mortality, admission to intensive care, and complications. However, our study found that people living with HIV-1 with adequate virological control did not present a severe course of COVID -19.

Objective Phaeohyphomycosis is an infection caused by pigmented fungi, which can be life-threatening in immunocompromised hosts and in disseminated disease. In adults with disseminated disease mortality is as high as 79%. Data in children is derived from case reports and series. We conducted this study to review the characteristics of phaeohyphomycoses in children. Methods We conducted this study following the PRISMA 2020 guideline for reporting systematic reviews. We performed a review of the reported cases of pediatric phaeohyphomycoses in core bibliographic databases published in the English and Spanish-language, between June 1977 and October 2021. We included all eligible cases in patients <18 years to determine the clinical characteristics, diagnosis, treatment, and outcomes. Results 130 cases were reviewed. Mean age was 8 years. The most common underlying conditions and risk factors included hematologic malignancies (32.5%), neutropenia (26.9%), steroid therapy (24.6%), trauma or surgery (23.1%), and children that received a transplant (14.6%). The most common presentation was localized infection (61.5%); skin and soft tissue infections were the most prevalent (25.4%). Exserohilum spp (20.8%) and Exophiala spp (17.7%) were the most common organisms isolated. Antifungal therapy remains as the most frequent treatment (87%). Overall mortality rate was 22.3% (localized 13.7% vs disseminated 37.3%). Conclusion The findings of this review suggest that phaeohyphomycoses in children has a better outcome compared to adults. We report a lower mortality rate in children when compared with adults in disseminated infection (37.3% vs 79%) and CNS infection (50% vs 60-70%). However, there is a wide variation in mortality rates according to infection site, treatment, and underlying conditions. Prospective studies are needed.