Joury Abdulaziz U, Alshehri Mona, Alhasan Mustafa
Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA.
King Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia.
Ochsner J. 2019 Summer;19(2):169-173. doi: 10.31486/toj.17.0113.
Fungal infections are known for their chronicity and latency and are difficult to eradicate. The pathophysiology of these invading pathogens and the resulting alteration of the immune system are not fully understood. Fungal meningitis is associated with significant rates of morbidity and mortality, especially among immunocompromised patients. Cryptococcosis, an infection secondary to the fungus , is one of the most important opportunistic infections among patients with human immunodeficiency virus (HIV), and expediting treatment is crucial. We report the case of a 28-year-old male with HIV who had a simultaneous co-infection with cryptococcal meningitis and complex (MAC). The patient required a 2-week induction phase of antifungal medication with amphotericin B and flucytosine. Despite aggressive initial therapy and the patient's significant clinical improvement, his radiologic findings and lumbar puncture showed persistent cryptococcal infection. Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis.
真菌感染以其慢性病程和潜伏期而闻名，且难以根除。这些入侵病原体的病理生理学以及由此导致的免疫系统改变尚未完全明了。真菌性脑膜炎与较高的发病率和死亡率相关，尤其是在免疫功能低下的患者中。隐球菌病是由真菌引起的一种感染，是人类免疫缺陷病毒（HIV）患者中最重要的机会性感染之一，加快治疗至关重要。我们报告一例28岁男性HIV患者，同时合并隐球菌性脑膜炎和播散性鸟分枝杆菌复合体（MAC）感染。该患者需要接受为期2周的两性霉素B和氟胞嘧啶抗真菌药物诱导治疗阶段。尽管初始治疗积极且患者临床症状有显著改善，但其影像学检查结果和腰椎穿刺显示隐球菌感染持续存在。即使在免疫抑制患者中，隐球菌病和MAC并发感染也极为罕见。在我们的病例中，这种并发感染与隐球菌病诱导治疗阶段的疗程延长有关。
