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Cryptococcosis and tuberculosis co-infection at a university hospital in Taiwan, 1993–2006

  • Clinical and Epidemiological Study
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Abstract

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.

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Conflict of interest

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Br., Yunlin, Taiwan

    C.-T. Huang

  2. Department of Internal Medicine, National Taiwan University Hospital, # 7 Chung-Shan South Road, Taipei, 100, Taiwan

    S.-C. Ku & C.-J. Yu

  3. School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan

    Y.-J. Tsai

  4. Department of Nursing, Chang Gung Institute of Technology, Tao-Yuan, Taiwan

    J.-Y. Fan

Authors
  1. C.-T. Huang
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  2. Y.-J. Tsai
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  3. J.-Y. Fan
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  4. S.-C. Ku
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  5. C.-J. Yu
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Corresponding author

Correspondence to S.-C. Ku.

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Huang, CT., Tsai, YJ., Fan, JY. et al. Cryptococcosis and tuberculosis co-infection at a university hospital in Taiwan, 1993–2006. Infection 38, 373–379 (2010). https://doi.org/10.1007/s15010-010-0045-9

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  • DOI: https://doi.org/10.1007/s15010-010-0045-9

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