Disseminated rhodococcus equi infection in HIV infection despite highly active antiretroviral therapy

Abstract

BackgroundRhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people. In the context of HIV infection, R.equi infection (rhodococcosis) is regarded as an opportunistic disease, and its outcome is influenced by highly active antiretroviral therapy (HAART).Case presentationWe report two cases of HIV-related rhodococcosis that disseminated despite suppressive HAART and anti-rhodococcal treatment; in both cases there was no immunological recovery, with CD4+ cells count below 200/μL. In the first case, pulmonary rhodococcosis presented 6 months after initiation of HAART, and was followed by an extracerebral intracranial and a cerebral rhodococcal abscess 1 and 8 months, respectively, after onset of pulmonary infection. The second case was characterized by a protracted course with spread of infection to various organs, including subcutaneous tissue, skin, colon and other intra-abdominal tissues, and central nervous system; the spread started 4 years after clinical resolution of a first pulmonary manifestation and progressed over a period of 2 years.ConclusionsOur report highlights the importance of an effective immune recovery, despite fully suppressive HAART, along with anti-rhodococcal therapy, in order to clear rhodococcal infection.

Disseminated Rhodococcus equi infection in a patient with Hodgkin’s lymphoma

“…Namely, bacteriemia, relapses and dissemination of the infection also registered after chemotherapy cessation and making the diagnosis. According to data from the literature, relapses, bacteriemia and visceral dissemination of R. equi infection rarely occures in HIV negative persons in contrast to the patients with AIDS 4,14,16,[27][28][29][30] .…”

Immunocompromised patients and their pets: Still best friends?

“…It infects deeply immunosuppressed humans, most frequently causing cavitary pneumonia (Perez-Silvestre et al, 2010). The microorganism may disseminate to the brain and other organs (Corti et al, 2009;Ferretti et al, 2011). The risk of zoonotic transmission of the microorganism is unclear since it has been documented only in a fraction of reported cases (Harvey and Sunstrum, 1991).…”

Other HIV-Associated Pneumonias

“…The most active antimicrobial agents include glycopeptides, carbapenems, aminoglycosides, fluoroquinolones, macrolides, trimethoprim-sulfamethoxazole, rifampin, tigecycline, and linezolid. 85,100,101 A combination of at least 2 intravenous antimicrobial agents based on in vitro susceptibility is recommended for the initial therapy, followed by a prolonged course of combined oral antimicrobial agents. The duration of treatment is also individualized for each patient depending on clinical and radiologic responses, as well as CD4 cell count measurements.…”

“…The duration of treatment is also individualized for each patient depending on clinical and radiologic responses, as well as CD4 cell count measurements. 85,101 …”