title: Multiple opportunistic fungal infections in an individual with severe HIV disease: A case report.
abstract: BACKGROUND
  Fungal infections have been commonly diagnosed in individuals with advanced HIV disease. Cryptococcosis, pneumocystosis, and histoplasmosis are the most frequent systemic mycoses in people suffering from HIV/AIDS.
  
  
  METHODS
  We report a case of multiple fungal infections in an advanced AIDS-patient. A 33-year-old HIV-positive man from Brazil was hospitalized due to diarrhea, dyspnea, emaciation, hypoxemia, extensive oral thrush, and a CD4+ T lymphocyte count of 20cells/mm(3). Honeycombed-structures consistent with Pneumocystis jirovecii were observed by direct immunofluorescence in induced sputum. Cryptococcus neoformans was recovered from respiratory secretion and cerebrospinal fluid cultures. Histopathology of the bone marrow also revealed the presence of Histoplasma capsulatum. Molecular assays were performed in a sputum sample. Nested-PCR confirmed the presence of P. jirovecii and H. capsulatum; qPCR multiplex was positive for C. neoformans and H. capsulatum. With the treatment of antifungal drugs the patient progressed satisfactorily.
  
  
  CONCLUSIONS
  The diagnosis of several systemic mycoses demonstrates the vulnerability of advanced AIDS-patients. Thus, the detection of AIDS cases in the early stages of infection is necessary for a prompt and adequate introduction of HAART therapy, and the use of prophylaxis to control opportunistic infections.
authors.affiliation: Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Almeida-Silva
authors.affiliation: Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Lisandra Serra
authors.initials: LS
authors.lastname: Damasceno
authors.affiliation: Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Maria Jose Buitrago
authors.initials: MJ
authors.lastname: Serna
authors.affiliation: Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Valero
authors.affiliation: Serviço de Anatomia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Leonardo Pereira
authors.initials: LP
authors.lastname: Quintella
authors.affiliation: Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Almeida-Paes
authors.affiliation: Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors.forename: Mauro de Medeiros
authors.initials: Mde M
authors.lastname: Muniz
authors.affiliation: Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. Electronic address: rosely.zancope@ini.fiocruz.br.
authors.forename: Rosely Maria
authors.initials: RM
authors.lastname: Zancope-Oliveira
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology*; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D060085:Coinfection; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D057210:Delayed Diagnosis; D006658:Histoplasma / Q000302:isolation & purification; D006660:Histoplasmosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000382:microbiology*; D045363:Pneumocystis carinii / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000935:Antifungal Agents
keywords: AIDS; Criptococosis; Cryptococcosis; Histoplasmosis; Immune response inflammatory syndrome; Neumocistosis; Pneumocystosis; Sida; Síndrome inflamatorio de reconstitución inmune