Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients

Abstract

Abstract. Coinfection with tuberculosis in some countries occurs in 8-15% of human immunodeficiency virus (HIV) -infected patients who have histoplasmosis. This coinfection interferes with prompt diagnosis, and treatment is difficult because of drug interactions. We retrospectively reviewed the cases of 14 HIV-infected patients who had concomitant tuberculosis and histoplasmosis. The most frequent clinical manifestations were weight loss (85.7%), asthenia (78.5%), and fever (64.2%). The diagnosis of histoplasmosis was made primarily by histopathology (71.4%), and the diagnosis of tuberculosis was made by means of direct microscopic examination (71.4%). Death occurred in two patients, and relapse of both infections occurred in one patient. Moxifloxacin was substituted for rifampicin in six patients, with good outcomes noted for both infections. The clinical presentation does not readily identify acquired immunodeficiency syndrome (AIDS) patients who have tuberculosis and histoplasmosis. The use of a fluoroquinolone as an alternative agent in place of rifampicin for tuberculosis allows effective therapy with itraconazole for histoplasmosis.

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

“…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). Finally, coinfection with H. capsulatum and M. tuberculosis is frequent in some areas where histoplasmosis is endemic and may involve important implications for treatment (57).…”

Colonic Bleeding Due to Histoplasma and Mycobacterium Coinfection in Renal Transplant Patient

“…It is important to keep in mind that rifampin, in spite of being the preferred drug to treat tuberculosis, is a strong cytochrome P450 inducer, decreasing serum levels of itraconazole and interfering with its efficacy, as well as with some immunosuppressants like calcineurin inhibitors and sirolimus [15,16]. An alternative regimen including quinolones, like levofloxacin, can be done with adequate efficacy, and there are some reports with favorable outcomes in renal transplants [17].…”

Concomitant disseminated histoplasmosis and disseminated tuberculosis after tumor necrosis factor inhibitor treatment: a case report

“…However, new epidemiological and genetic data support the fact that in some instances, the body can successfully eradicate M. tuberculosis infection before an adaptive immune response develops, which is referred as early clearance [3]. It is important to point out that both Histoplasmosis and TB can be found in disseminated form in immunosuppressed hosts, yet co-infection is rare with only a few cases having been reported, to our knowledge all in HIV patients [4]. We are reporting a case of an immunosuppressed patient due to TNF-α inhibitor therapy, who was co-infected with Hisptolasmosis and TB, both in disseminated form.…”