COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome

Abstract

Background: Several viral, bacterial and fungal co-infections have been associated with increased morbidity and mortality among patients with COVID-19. We report a fatal case of severe COVID-19 pneumonia in a patient with a recent diagnosis of advanced HIV disease complicated by cryptococcal meningitis, disseminated tuberculosis and acute ischemic stroke. Case Presentation: A 37-year-old Ugandan woman was diagnosed with HIV infection 8 days prior to her referral to our center. She was antiretroviral naïve. Her chief complaints were worsening cough, difficulty in breathing, fever and altered mental status for 3 days with a background of a 1-month history of coughing with associated drenching night sweats and weight loss. The reverse transcriptase-polymerase chain reaction for SARS-CoV-2 of her nasopharyngeal swab sample was positive. Chest radiograph demonstrated military pattern involvement of both lungs. The serum and cerebrospinal fluid cryptococcal antigen tests were positive. Urine lipoarabinomannan and sputum GeneXpert were positive for Mycobacterium tuberculosis. Computed tomography of the brain showed a large acute ischemic infarct in the territory of the right middle cerebral artery. Regardless of the initiation of treatment, that is, fluconazole 1200 mg once daily, enoxaparin 60 mg, intravenous (IV) dexamethasone 6 mg once daily, oral fluconazole 1200 mg once daily, IV piperacillin/tazobactam 4.5 g three times daily and oxygen therapy, the patient passed on within 36 hours of admission. Conclusion: Co-infections worsen COVID-19 outcomes.

COVID-19 associated with cryptococcosis: a scoping review

“…Of the total number of patients, the male sex was affected in 48 cases while the median age was 60 years, with statistically significant differences between the two groups: alive versus dead in both variables ( p value = 0.0203 and 0.0332, respectively). Of 60 patients with available information, 31 were from the United States 15 , 16 , 19 – 40 (51.6%), 8 from Peru 41 (13.3%), 7 from Brazil 14 , 42 – 47 (11.6%), and 2 from India 48 , 49 and Italy 50 , 51 (3.3% each), while the rest were from Canada, 52 Colombia, 53 China, 54 the Czech Republic, 55 the UK, 56 Uganda, 57 Qatar, 58 Lebanon, 59 Spain, 60 and Germany 61 ( n = 1; 1.7% each).…”

CT imaging of HIV-associated pulmonary disorders in COVID-19 pandemic

“… 77 This is also true for HIV-positive patients; to date, there have been only case reports published on concomitant COVID-19, HIV, and other disease, typically represented by fungal pneumonia or tuberculosis 108,109. 78. , 79.…”