title: Disseminated Rhodococcus equi infection in HIV infection despite highly active antiretroviral therapy.
abstract: BACKGROUND
  Rhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people. In the context of HIV infection, R.equi infection (rhodococcosis) is regarded as an opportunistic disease, and its outcome is influenced by highly active antiretroviral therapy (HAART).
  
  
  METHODS
  We report two cases of HIV-related rhodococcosis that disseminated despite suppressive HAART and anti-rhodococcal treatment; in both cases there was no immunological recovery, with CD4+ cells count below 200/μL. In the first case, pulmonary rhodococcosis presented 6 months after initiation of HAART, and was followed by an extracerebral intracranial and a cerebral rhodococcal abscess 1 and 8 months, respectively, after onset of pulmonary infection. The second case was characterized by a protracted course with spread of infection to various organs, including subcutaneous tissue, skin, colon and other intra-abdominal tissues, and central nervous system; the spread started 4 years after clinical resolution of a first pulmonary manifestation and progressed over a period of 2 years.
  
  
  CONCLUSIONS
  Our report highlights the importance of an effective immune recovery, despite fully suppressive HAART, along with anti-rhodococcal therapy, in order to clear rhodococcal infection.
authors.affiliation: Department of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy. ferretti.francesca@hsr.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferretti
authors.forename: Antonio
authors.initials: A
authors.lastname: Boschini
authors.forename: Cristiana
authors.initials: C
authors.lastname: Iabichino
authors.forename: Simonetta
authors.initials: S
authors.lastname: Gerevini
authors.forename: Paola
authors.initials: P
authors.lastname: De Nardi
authors.forename: Monica
authors.initials: M
authors.lastname: Guffanti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Balconi
authors.forename: Adriano
authors.initials: A
authors.lastname: Lazzarin
authors.forename: Paola
authors.initials: P
authors.lastname: Cinque
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000473:pathology; D000193:Actinomycetales Infections / Q000188:drug therapy* / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D016929:Rhodococcus equi / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents