Cryptococcosis and tuberculosis co-infection at a university hospital in Taiwan, 1993-2006.
BACKGROUND
The human immunodeficiency virus (HIV) epidemic and increasing use of immunosuppressive agents have increased the prevalence of both cryptococcosis and tuberculosis (TB). However, the status of co-infection with both pathogens remains unknown.


METHODS
This study retrospectively reviewed patient records of cryptococcosis and TB co-infection from 1993 to 2006. The temporal sequence of co-infection was defined as either concurrent or sequential. Data collected included patient demographics, HIV status, co-morbidities, clinical manifestations, treatment strategies, and outcome at 1-year follow-up.


RESULTS
There were 23 patients with cryptococcosis and TB co-infection, representing 5.4% of cryptococcosis or 0.6% of TB cases. Eleven (48%) patients were HIV-infected, and no underlying disease or immunocompromised state could be identified in six (26%) patients. Twelve (52%) patients presented with concurrent infection, but diagnosis of co-infection could be achieved simultaneously in only three (13%). Constitutional symptoms, particularly fever and weight loss, were the most common presenting symptoms, developing in more than two-thirds of the patients. The majority (83%) of the patients made a good recovery following dual antifungal and anti-TB therapy. There were three mortalities at the 1-year follow-up, which might be attributable to a delay in diagnosis and treatment of co-infection. The outcomes of HIV-infected and non-HIV-infected patients were not significantly different.


CONCLUSIONS
Cryptococcosis and TB co-infection, although rare, develops in both immunocompromised and healthy individuals. Early diagnosis and treatment may improve patient prognosis. There should be a high index of suspicion in order to achieve a timely diagnosis in a TB endemic area.
Huang
C-T
CT
Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Br., Yunlin, Taiwan.
Tsai
Y-J
YJ
Fan
J-Y
JY
Ku
S-C
SC
Yu
C-J
CJ
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000150:complications; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology
D000890:Anti-Infective Agents