COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome.

Journal: Infection and drug resistance

Volume: 14

Issue: 

Year of Publication: 

Affiliated Institutions:  Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda. Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda.

Abstract summary 

Several viral, bacterial and fungal co-infections have been associated with increased morbidity and mortality among patients with COVID-19. We report a fatal case of severe COVID-19 pneumonia in a patient with a recent diagnosis of advanced HIV disease complicated by cryptococcal meningitis, disseminated tuberculosis and acute ischemic stroke.A 37-year-old Ugandan woman was diagnosed with HIV infection 8 days prior to her referral to our center. She was antiretroviral naïve. Her chief complaints were worsening cough, difficulty in breathing, fever and altered mental status for 3 days with a background of a 1-month history of coughing with associated drenching night sweats and weight loss. The reverse transcriptase-polymerase chain reaction for SARS-CoV-2 of her nasopharyngeal swab sample was positive. Chest radiograph demonstrated military pattern involvement of both lungs. The serum and cerebrospinal fluid cryptococcal antigen tests were positive. Urine lipoarabinomannan and sputum GeneXpert were positive for . Computed tomography of the brain showed a large acute ischemic infarct in the territory of the right middle cerebral artery. Regardless of the initiation of treatment, that is, fluconazole 1200 mg once daily, enoxaparin 60 mg, intravenous (IV) dexamethasone 6 mg once daily, oral fluconazole 1200 mg once daily, IV piperacillin/tazobactam 4.5 g three times daily and oxygen therapy, the patient passed on within 36 hours of admission.Co-infections worsen COVID-19 outcomes.

Authors & Co-authors:  Bongomin Felix F Sereke Senai Goitom SG Okot Jerom J Katsigazi Ronald R Kandole Tadeo Kiiza TK Oriekot Anthony A Olum Ronald R Atukunda Angella A Baluku Joseph Baruch JB Nakwagala Frederick F

Study Outcome 

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Statistics
Citations :  Alhumaid S, Al Mutair A, Al Alawi Z, et al. Coinfections with bacteria, fungi, and respiratory viruses in patients with SARS-CoV-2: a systematic review and meta-analysis. Pathogens. 2021;10(7):809. doi:10.3390/pathogens10070809
Authors :  10
Identifiers
Doi : 10.2147/IDR.S335711
SSN : 1178-6973
Study Population
Male,Female
Mesh Terms
Other Terms
COVID-19;HIV;co-infection;cryptococcal meningitis;stroke;tuberculosis
Study Design
Case Study,Cross Sectional Study
Study Approach
Country of Study
Uganda
Publication Country
New Zealand