COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome
Felix Bongomin,1,2 Senai Goitom Sereke,3 Jerom Okot,2 Ronald Katsigazi,1 Tadeo Kiiza Kandole,4 Anthony Oriekot,5 Ronald Olum,1 Angella Atukunda,6 Joseph Baruch Baluku,5 Frederick Nakwagala6 1Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;...
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2021-10-01
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| Series: | Infection and Drug Resistance |
| Subjects: | |
| Online Access: | https://www.dovepress.com/covid-19-hiv-associated-cryptococcal-meningitis-disseminated-tuberculo-peer-reviewed-fulltext-article-IDR |
| _version_ | 1819117972346634240 |
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| author | Bongomin F Sereke SG Okot J Katsigazi R Kandole TK Oriekot A Olum R Atukunda A Baluku JB Nakwagala F |
| author_facet | Bongomin F Sereke SG Okot J Katsigazi R Kandole TK Oriekot A Olum R Atukunda A Baluku JB Nakwagala F |
| author_sort | Bongomin F |
| collection | DOAJ |
| description | Felix Bongomin,1,2 Senai Goitom Sereke,3 Jerom Okot,2 Ronald Katsigazi,1 Tadeo Kiiza Kandole,4 Anthony Oriekot,5 Ronald Olum,1 Angella Atukunda,6 Joseph Baruch Baluku,5 Frederick Nakwagala6 1Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda; 3Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 4Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; 5Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda; 6Department of Medicine, Mulago National Referral Hospital, Kampala, UgandaCorrespondence: Felix BongominDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, UgandaTel +256-784-523-395Email drbongomin@gmail.comBackground: 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.Case Presentation: 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 Mycobacterium tuberculosis. 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.Conclusion: Co-infections worsen COVID-19 outcomes.Keywords: COVID-19, HIV, cryptococcal meningitis, stroke, tuberculosis, co-infection |
| first_indexed | 2024-12-22T05:41:28Z |
| format | Article |
| id | doaj.art-0a6d3d29ec964f3f85a1f4cc0ebddd14 |
| institution | Directory Open Access Journal |
| issn | 1178-6973 |
| language | English |
| last_indexed | 2024-12-22T05:41:28Z |
| publishDate | 2021-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Infection and Drug Resistance |
| spelling | doaj.art-0a6d3d29ec964f3f85a1f4cc0ebddd142022-12-21T18:37:10ZengDove Medical PressInfection and Drug Resistance1178-69732021-10-01Volume 144167417169604COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal FoursomeBongomin FSereke SGOkot JKatsigazi RKandole TKOriekot AOlum RAtukunda ABaluku JBNakwagala FFelix Bongomin,1,2 Senai Goitom Sereke,3 Jerom Okot,2 Ronald Katsigazi,1 Tadeo Kiiza Kandole,4 Anthony Oriekot,5 Ronald Olum,1 Angella Atukunda,6 Joseph Baruch Baluku,5 Frederick Nakwagala6 1Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda; 3Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 4Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; 5Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda; 6Department of Medicine, Mulago National Referral Hospital, Kampala, UgandaCorrespondence: Felix BongominDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, UgandaTel +256-784-523-395Email drbongomin@gmail.comBackground: 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.Case Presentation: 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 Mycobacterium tuberculosis. 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.Conclusion: Co-infections worsen COVID-19 outcomes.Keywords: COVID-19, HIV, cryptococcal meningitis, stroke, tuberculosis, co-infectionhttps://www.dovepress.com/covid-19-hiv-associated-cryptococcal-meningitis-disseminated-tuberculo-peer-reviewed-fulltext-article-IDRcovid-19hivcryptococcal meningitisstroketuberculosisco-infection |
| spellingShingle | Bongomin F Sereke SG Okot J Katsigazi R Kandole TK Oriekot A Olum R Atukunda A Baluku JB Nakwagala F COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome Infection and Drug Resistance covid-19 hiv cryptococcal meningitis stroke tuberculosis co-infection |
| title | COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome |
| title_full | COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome |
| title_fullStr | COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome |
| title_full_unstemmed | COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome |
| title_short | COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome |
| title_sort | covid 19 hiv associated cryptococcal meningitis disseminated tuberculosis and acute ischaemic stroke a fatal foursome |
| topic | covid-19 hiv cryptococcal meningitis stroke tuberculosis co-infection |
| url | https://www.dovepress.com/covid-19-hiv-associated-cryptococcal-meningitis-disseminated-tuberculo-peer-reviewed-fulltext-article-IDR |
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