The Simultaneous Occurrence of Histoplasmosis and Cryptococcal Fungemia: A Case Report and Review of the Literature

Abstract

Simultaneous infections with Cryptococcus neoformans and Histoplasma capsulatum are rare and typically occur in immunocompromised individuals, particularly AIDS patients. Because both of those fungi can spur the development of latent infections, it is generally unknown which organism was first present. The diagnosis of one fungus can hide the diagnosis of the other, leading to underdiagnoses and poor prognosis. We report a case of C. neoformans and H. capsulatum co-infection. We also performed a systematic review of the literature. Our patient, a 69-year-old HIV-negative man, presented with a 9-month history of a productive cough, dyspnea and wheezing. His history showed chronic obstructive pulmonary disease and type II diabetes mellitus (DM). Pulmonary lesions of unidentified etiology were noted. Cryptococcal involvement of the central nervous system was confirmed, and C. neoformans and H. capsulatum were also isolated from blood cultures. In the literature, we found ten cases of simultaneous histoplasmosis and cryptococcosis. Including our patient, all of the cases were located in North America and Latin America, except for two, one Indian and one African diagnosed in France. AIDS was the main predisposing factor, followed by DM and age >60 years. Several diagnostic methods were employed. A blood culture and bronchoalveolar lavage (BAL) culture resulted in the growth of C. neoformans in most of the cases. H. capsulatum was more often detected in BAL and bone marrow cultures. Although co-infection by these pathogens is severe, it can be cured if it is diagnosed and treated early. We emphasized the importance of clinical suspicion and differential diagnosis of systemic mycoses.

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

“…Uncontrolled hyperglycemia contributes to a poor prognosis of type 2 diabetes patients with cryptococcosis. Diabetes is a potential risk factor for IFD caused by unusual fungi, such as Histoplasma capsulatum . Fungi in patients with diabetes present increasing drug resistance.…”

Cryptococcal fungemia and probable histoplasmosis in a patient infected with HIV. Case report

“…A Review in PUBMED from 1970 to August/2018 was performed, and 12 cases of patients with coinfection by Histoplasma capsulatum and Cryptococcus spp were found. Other authors performed similar reviews [8,11]. In Colombia, in a series of 11 cases of Arango et al [3] a case of coinfection by histoplasmosis and cryptococcosis was reported.…”

<p>HIV-Associated Histoplasmosis: Current Perspectives</p>

“…50 There are some reports of co-infection with other opportunistic infections such as tuberculosis, 51 Pneumocystis jirovecii 52 and cryptococcal infection. 53 In one cohort from Columbia, co-infection with other opportunistic infection was found in 51% of the patients with disseminated histoplasmosis. Tuberculosis was the main co-infection (70%), followed by pneumocystosis (13%), cryptococcosis (13%) Salmonella infection (9%), and Cytomegalovirus (CMV) infection (9%).…”