A CASE OF AN HIV- POSITIVE PATIENT CO-INFECTED WITH MULTIDRUG-RESISTANT TUBERCULOSIS

Authors

  • Nina Yancheva-Petrova Medical University – Sofia / Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria
  • Vladimir Milanov Medical University – Sofia, Hospital for Pulmonary Diseases „St. Sophia“, Sofia, Bulgaria
  • Dimitar Strashimirov Medical University – Sofia / Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria
  • Dimitar Kostadinov Medical University – Sofia / Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria

Keywords:

HIV, tuberculosis (TB), multidrug-resistant TB (MDR-TB), atypical presentation, therapeutic challenge

Abstract

Tuberculosis has a greater impact on morbidity and mortality in HIV-1-infected individuals than the rest of the opportunistic infections. We report
a case of 57-year-old HIV-infected patient co-infected with multidrug- resistant tuberculosis (MDR-TB).

The patient`s leading clinical syndromes were fever, diarrhoea and weight loss. The meticulously performed laboratory investigations revealed severe immune suppression and high HIV viral load. Microbiological and parasitological tests confirmed the presence of two AIDS-defining conditions: disseminated candidiasis and cryptosporidiosis. Sputum smear microscopy for acid-fast bacilli was negative but sputum culture showed positive result for Mycobacterium tuberculosis. Drug susceptibility testing determined resistance to isoniazid and rifampicin (MDR-TB). The diagnosis was confirmed with Xpert-MTB/RIF PCR test. Treatment continued with second-line anti-TB drugs, together with antiretroviral therapy.

Culture conversion was recorded in the first month. The outcome was reported as „cured“ after 16 months` therapy. This case shows yet again that the clinical manifestation of tuberculosis in HIV-infected patients is very atypical. Multidrug-resistant tuberculosis requires prolonged treatment and
represents therapeutic challenge because of the possibility of adverse drug reactions.

Author Biographies

Nina Yancheva-Petrova, Medical University – Sofia / Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria

Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University – Sofia,

Department of AIDS, Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria

Vladimir Milanov, Medical University – Sofia, Hospital for Pulmonary Diseases „St. Sophia“, Sofia, Bulgaria

Department of Pulmonary Diseases

Dimitar Strashimirov, Medical University – Sofia / Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria

Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University – Sofia,

Department of AIDS, Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria

Dimitar Kostadinov , Medical University – Sofia / Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria

Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University – Sofia,

Department of AIDS, Specialised Hospital for Active Treatment of Infectious and Parasitic Diseases „Prof. Iv. Kirov“, Sofia, Bulgaria

References

Cascade data use manual: to identify gaps in HIV and health services for programme improvement. World Health Organization; 2018 [30 August 2018].

WHO implementation tool for monitoring the toxicity of new antiretroviral and antiviral medicines in HIV and viral hepatitis programmes. World Health Organization; 2018 [18 July 2018].

Van der Werf M, Ködmön C, Zucs P, Hollo V, Amato-Gauci A, Pharris A. Tuberculosis and HIV coinfection in Europe: looking at one reality from two angles. AIDS. 2016; 30(18): 2845-2853.

Efsen A, Schultze A, Miller R, Panteleev A, Skrahin A, et al. Management of MDR-TB in HIV-coinfected patients in Eastern Europe: Results from the TB:HIV study. J Infect.2018; 76(1):44-54.

Latent TB Infection : Updated and consolidated guidelines for programmatic management. World Health Organization; 2018 [February 2018].

Magis-Escurra C, Günther G, Lange C, Alexandru S, Altet N, et al. Treatment outcomes of MDR-TB and HIV co-infection in Europe. Europ Respir J. 2017; 49(6):1602363.

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Published

2019-06-27

How to Cite

Yancheva-Petrova, N., Milanov, V., Strashimirov, D., & Kostadinov , D. (2019). A CASE OF AN HIV- POSITIVE PATIENT CO-INFECTED WITH MULTIDRUG-RESISTANT TUBERCULOSIS. PROBLEMS of Infectious and Parasitic Diseases, 47(1), 21–24. Retrieved from https://pipd.ncipd.org/index.php/pipd/article/view/47_1_4_CASE_OF_AN_HIV-_POSITIVE_PATIENT_CO-INFECTED_WITH_MULTIDR

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