Pulmonary coinfection by Pneumocystis jiroveci and Cryptococcus neoformans

Abstract

We communicate the diagnosis by microscopy of a pulmonary coinfection produced by Cryptococcus neoformans and Pneumocystis jiroveci, from a respiratory secretion obtained by bronchoalveolar lavage of an AIDS patient. Our review of literature identified this coinfection as unusual presentation. Opportunistic infections associated with HIV infection are increasingly recognized. It may occur at an early stage of HIV-infection. Whereas concurrent opportunistic infections may occur, coexisting Pneumocystis jiroveci pneumonia (PCP) and disseminated cryptococcosis with cryptococcal pneumonia is uncommon. The lungs of individuals infected with HIV are often affected by opportunistic infections and tumours and over two-thirds of patients have at least one respiratory episode during the course of their disease. Pneumonia is the leading HIV-associated infection. We present the case of a man who presented dual Pneumocystis jiroveci and cryptococcal pneumonia in a patient with HIV. Definitive diagnosis of PCP and Cryptococcus requires demonstration of these organisms in pulmonary tissues or fluid. In patients with < 200/microliter CD4-lymphocytes, a bronchoalveolar lavage should be performed. This patient was successfully treated with amphotericin B and trimethoprim sulfamethoxazole. After 1 week the patient showed clinical and radiologic improvement and was discharged 3 weeks later.

A Multiplex Real-Time PCR Assay for Identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii in Samples from AIDS Patients with Opportunistic Pneumonia

“…Several reports of cases of mixed infections have been published, and for all of them the definitive diagnosis was based on microbiological evidence. Bava et al (47) reported a case in which a patient had mixed infection due to Cryptococcus and Pneumocystis. Mixed infections of H. capsulatum and C. neoformans (46), as well as of P. jirovecii and H. capsulatum, have also been reported in individuals from areas (48).…”

“…Moreover, multiplex real-time PCR (Mrt-PCR) protocols allow the detection of mixed infections that cannot be detected by routine protocols. Mixed infections involving H. capsulatum, C. neoformans, and P. jirovecii have been described (46)(47)(48).…”

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

“…(479)(480)(481)(482), Cryptococcus spp. (483)(484)(485), Candida spp. (486), Histoplasma capsulatum (487), Mycobacterium tuberculosis (488)(489)(490)(491), Legionella pneumophila (492)(493)(494)(495), Salmonella enterica serovar Enteritidis (496), cytomegalovirus (497)(498)(499)(500)(501)(502)(503)(504)(505)(506), influenza virus (507-509), herpesvirus 6 (510), Strongyloides stercoralis (511,512), Toxoplasma gondii (513), and Trichomonas vaginalis (514).…”

Epidemiology Opportunistic Mycoses

“…безусловно, важна своевременная диагностика криптококкоза у ВИч-инфицированных больных, которая должна быть комплексной с включением обязательного микологического исследования ликвора и другого патологического материала, в зависимости от локализации очага поражения [47]. Наличие легочной сочетанной инфекции подтверждено у больного СпИД в Китае путем выделения из бронхоаль-веолярного лаважа С. neoformans и Pneumocystis jiroveci [48].…”