amphotericin-b and Tuberculosis--Miliary

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Antitubercular Agents; Critical Illness; Dermatomycoses; Histoplasma; Histoplasmosis; Humans; Itraconazole; Male; Tuberculosis, Miliary; Young Adult

Histoplasmosis is an endemic fungal infection that causes no symptoms or minor self-limited illnesses in most cases. Severe forms are commonly reported in patients with immunodeficiency disorders; histoplasmosis is considered to be an opportunistic infection in patients with AIDS. We report a case of disseminated histoplasmosis in a patient with no induced active suppression of the immune response. The infection was fulminant, and antifungal treatment was delayed because of a misdiagnosis of tuberculosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Antitubercular Agents; Brazil; Bronchoalveolar Lavage Fluid; Delayed Diagnosis; Diagnostic Errors; Disseminated Intravascular Coagulation; Fatal Outcome; French Guiana; Histoplasma; Histoplasmosis; HIV Seronegativity; Humans; Immunocompetence; Lung Diseases, Fungal; Male; Mining; Occupational Diseases; Tuberculosis, Miliary

Cryptococcosis caused by Cryptococcus neoformans has a wide range of clinical presentations, varying from asymptomatic colonization of the respiratory airways to the dissemination of infection into different parts of body. It is more common among immunosupressed patients such as human immunodeficiency virus (HIV) positive ones. In this report we present a case with C. neoformans meningitis and miliary pulmonary infiltrates suggesting pulmonary tuberculosis without HIV infection. A-70-years-old male was admitted to the hospital with mental confusion, 3-weeks history of headache, weight loss, dry cough and fatigue. Physical examination was normal except neck stiffness. Cerebrospinal fluid (CSF) white cell count was 120/mm3 (80% polimorphonuclear cells). Gram staining of CSF revealed poorly stained gram-positive yeast cells. Empirical therapy with lipozomal amphotericin B, ceftriaxone and ampicillin combination was started. When C. neoformans growth was detected on CSF culture, ceftriaxone and ampicillin were discontinued. Patient became conscious at 24th hour of the treatment. Peripheric blood flow-cytometric analysis revealed a significant decrease in absolute CD4+ T lymphocytes, and in CD8+28+ T lymphocytes in addition a significant increase in natural killer cell ratio. Blood immunoglobulin and complement levels were found normal. Cranial magnetic resonance imaging and computerized tomogralphy (CT) of the abdomen were normal, however, chest CT revealed multiple parenchymal millimetric nodular infiltrations on both sides and minimal fibrotic alterations. Acid-fast staining of CSF, tuberculosis culture, tuberculosis PCR results and repeated HIV serology were found negative. Despite the lack of microbiological confirmation, empirical antituberculosis treatment was also started with the suspicion of miliary tuberculosis as the patient had a symptom of long-term dry cough, miliary infiltrations on chest CT, anergic tuberculin skin test and a history of pulmonary tuberculosis in childhood. After two weeks, amphotericin B was changed to oral fluconazole which was continued for an additional eight weeks. Antituberculosis therapy was given for nine months. Control chest CT taken after four months of antituberculosis therapy revealed improvement of the lesions. This presentation emphasizes the fact that cryptococcal infections may develop in HIV negative patients, even together with tuberculosis in certain cases and radiological findings of the two infections may

Topics: Aged; Amphotericin B; Antifungal Agents; Antitubercular Agents; CD4-CD8 Ratio; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Fluconazole; HIV Seronegativity; Humans; Leukocyte Count; Male; Tuberculosis, Miliary

Topics: Adult; Amphotericin B; Fever; Fever of Unknown Origin; Histoplasmosis; Humans; Male; Middle Aged; Tuberculosis, Miliary

Topics: Amphotericin B; Antitubercular Agents; Blastomycosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Tuberculosis, Miliary

Topics: Amphotericin B; Coccidioidomycosis; Diagnosis, Differential; Drug Therapy; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Pathology; Prognosis; Radiography, Thoracic; Serologic Tests; Skin Tests; Toxicology; Tuberculosis; Tuberculosis, Miliary