Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients
Tuberculosis and Histoplasmosis Co-Infection in AIDS Patients
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DOI：
10.4269/ajtmh.2012.12-0292
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发表时间：
2012-12-01
影响因子：
3.3
通讯作者：
Restrepo, Angela
中科院分区：
文献类型：
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作者：
Agudelo, Carlos A.;Restrepo, Carlos A.;Restrepo, Angela
在一些国家，8%-15%的患有组织胞浆菌病的人类免疫缺陷病毒(HIV)感染者会合并结核病。这种重叠感染干扰了及时的诊断，而且由于药物相互作用，治疗很困难。我们回顾了14例HIV感染者合并肺结核和组织胞浆菌病的病例。最常见的临床表现为体重减轻(85.7%)、乏力(78.5%)和发热(64.2%)。组织胞浆菌病的诊断以组织病理学为主(71.4%)，结核的诊断以直接镜检为主(71.4%)。两名患者死亡，一名患者两种感染均复发。在6名患者中，莫西沙星被取代了利福平，两种感染都有良好的结果。临床表现不容易确定患有结核病和组织胞浆菌病的获得性免疫缺陷综合征(AIDS)患者。使用氟喹诺酮替代利福平治疗结核病，可有效治疗组织胞浆菌病。
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.