Fungal Bloodstream Co-infection by Trichosporon asahii in a COVID-19 Critical Patient: Case Report and Literature Review.

Opportunistic infections are serious complications in critically ill COVID-19 patients, especially co-infections with bacterial and fungal agents. Here we report a rare case of bloodstream co-infection by Trichosporon asahii, an emerging yeast, and Acinetobacterbaumannii, an opportunistic nosocomial pathogen, both multidrug resistant, in a tertiary hospital from southern Brazil. A review of the literature regarding similar cases is also included. Treatment with multiple antimicrobials failed, and the patient progressed to death four days after the diagnosis of bacteremia and fungemia.

COVID-19-Associated Histoplasmosis in an AIDS Patient.

Most reports associating fungal infections with COVID-19 have been cases of invasive aspergillosis. Here, we report a case of severe histoplasmosis and COVID-19 infections in an HIV patient in Rio Grande, Southern Brazil. Histoplasmosis must be included as a diagnostic possibility in opportunistic fungal co-infections in COVID-19 patients with AIDS, mainly in endemic areas.

Zika Virus Infection and Differential Diagnosis in a Cohort of HIV-Infected Patients.

BACKGROUND: Zika virus (ZIKV) emergence in South America revealed the lack of knowledge regarding clinical manifestations in HIV-infected individuals. OBJECTIVES: We described the clinical characteristics, laboratory manifestations, differential diagnosis, and outcome of ZIKV infection in a large, single-center cohort of HIV-infected patients. METHODS: HIV-infected patients aged 18 years and older with clinical suspected arboviral disease from an ongoing cohort were followed from February 2015 through December 2015. Acute serum samples were tested for ZIKV, dengue virus (DENV), and chikungunya virus by real-time reverse transcriptase polymerase chain reaction, anti-DENV immunoglobulin (Ig)M/IgG, and syphilis assays; convalescent samples were tested for anti-DENV IgM/IgG; and urine samples were tested for ZIKV by real-time reverse transcriptase polymerase chain reaction. ZIKV disease was defined according to the Pan American Health Organization (PAHO) guidelines. RESULTS: Of 101 patients, ZIKV was confirmed in 43 cases and suspected in 34, and another diagnosis was assumed for 24 patients (dengue, secondary/latent syphilis, respiratory infections, human parvovirus B19, adverse drug reaction, musculoskeletal disorders, and acute gastroenteritis). ZIKV-confirmed and ZIKV-suspected patients reported similar signs and symptoms. Pruritic rash was the most common symptom, followed by myalgia, nonpurulent conjunctivitis, arthralgia, prostration, and headache. In the short-term follow-up [median 67.5 days (interquartile range: 32-104.5)], CD4 cell count (Z = -0.831, P = 0.406) and HIV viral load (Z = -0.447, P = 0.655) did not change significantly after ZIKV infection. There were no hospitalizations, complications, or deaths. CONCLUSIONS: Among HIV-infected patients with suspected arboviral disease, 42.6% were ZIKV-infected. CD4 cell counts and HIV viral load were not different after ZIKV infection. Differential diagnosis with other diseases and adverse drug reaction should be evaluated.

Manifestações clínicas e laboratoriais de dengue em uma coorte de pacientes infectados pelo HIV, acompanhados no Instituto Nacional de Infectologia, Fiocruz, Rio de Janeiro, de 2008 a 2014

A associação entre doenças tropicais e a infecção pelo vírus da imunodeficiência humana (HIV) é descrita sobretudo em áreas onde ambas as infecções são endêmicas. O desequilíbrio imune que ocorre em pacientes infectados pelo HIV favorece manifestações graves como nos casos de coinfecções com malária, leishmaniose e doença de Chagas. No entanto, a coinfecção HIV e dengue tem sido pouco estudada. A ativação das células T e a presença de outros mediadores de inflamação nos casos de dengue grave parece não ocorrer com frequência nos pacientes com HIV, em função da imunodepressão associada à retrovirose. A hipótese de interferência da coinfecção na história natural de ambas as infecções é uma possibilidade a ser avaliada. O Instituto Nacional de Infectologia Evandro Chagas (INI) é referência para as duas doenças e, portanto, campo ideal para desenvolver pesquisas nessa área Neste estudo foram analisados 171 pacientes com coinfecção HIV/Dengue acompanhados no INI entre 2008 e 2014, com prevalência de 3,74%. Esta é a maior série de casos de coinfecção HIV/Dengue da literatura. Os sintomas mais frequentes foram febre, mialgia e prostração. Plaquetopenia e leucopenia foram os achados laboratoriais mais encontrados. Foi observada uma sensibilidade superior da classificação da Organização Mundial de Saúde de 2009 em comparação com a classificação de 1997 na definição de casos suspeito de dengue na coorte de pacientes com HIV. Apesar da manifestação clinica de dengue nos pacientes com HIV ser frequentemente mais branda comparada à descrita na literatura em pacientes hígidos, esses pacientes podem eventualmente apresentar piora na evolução por dengue, sendo necessário melhorar a vigilância e o monitoramento clínico.