Naslov
Fever in an HIV-infected person – a case report

Autori
Didović, Diana ; Romih Pintar, Vanja ; Lukas, Davorka ; Begovac, Josip

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Skup
2nd South-East European Conference on Travel, Tropical, Migration Medicine and HIV and the 3rd Croatian Conference on Travel, Tropical, Migration Medicine and HIV

Mjesto i datum
Dubrovnik, Hrvatska, 04.04.2019. - 07.04.2019

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
HIV ; fever

Sažetak
INTRODUCTION: Untreated HIV infection significantly increases the risk of acquiring opportunistic infections (OIs) due to various pathogens. OIs were a major cause of morbidity and mortality in HIV-infected patients prior to the development of effective antiretroviral therapy (ART). Before the widespread use of Pneumocystis jirovecii prophylaxis and ART, Pneumocystis jirovecii pneumonia (PCP) occurred in 70% to 80% of HIV-infected patients. CASE REPORT: We present a 39-year-old patient hospitalized at the University Hospital for Infectious Diseases, Zagreb, who presented with 20-days of fever night sweats, weight loss (8 kg in the last two weeks) and fatigue. He lived in Dalmatia and reported unprotected sex with other men. On the initial physical examination the patient had palpable axillary lymph nodes and hepatosplenomegaly. Laboratory findings showed pancytopenia with slightly elevated liver transaminases levels, LDH and inflammatory markers. Antigen/antibody HIV test turned out positive. The CD4+ lymphocyte T count was 8/μL while HIV-1 RNA viral load was 307 000 copies per millilitre. The chest X ray showed no abnormality and abdominal ultrasound confirmed hepatosplenomegaly. A sternal bone marrow aspirate showed numerous phagocytes with blue inclusions which were pathognomonic for infection caused by Leishmania spp. Treatment with liposomal amphotericin B for visceral leishmaniasis (VL) was started. ART with abacavir/lamivudine plus raltegravir was initiated on the eighth day of hospital stay. However, fever did persist and the patient developed dyspnea and a dry cough. Repeated chest X ray showed bilateral diffuse interstitial infiltrates, while chest CT scan showed diffuse interstitial lesions and also ground-glass opacifications. Bronchoscopy was performed and since Pneumocystis jirovecii PCR was positive in bronchoalveolar lavage, treatment with therapeutic doses of trimethoprim-sulfamethoxazole was initiated and lasted for 21 days. During further evaluations our patients’ viral load declined while CD4 lyT levels increased. He hadn’t had no VL relapses and received secondary PCP prophylaxis and VL prophylaxis. RESULTS: All children were adopted from Democratic Republic of the Congo. Median age was 2, 8 years (range 1, 9 to 4, 1). Diagnostic tests in most patients included routine laboratory tests, stool examination, testing for HIV and viral hepatitides, serological testing for MMR and screening for malaria. 5 (46%) patients were asymptomatic, 3 (27%) had watery diarrhea while 3 (27%) had fever, shivers and abdominal pain. The latter three were diagnosed with malaria. Among children with watery diarrhea two of them were positive for Giardia lamblia while Entamoeba histolytica was isolated in one asymptomatic patient. One patient was diagnosed with chronic B hepatitis and one patient with hepatitis C. CONCLUSION: Visceral leishmaniasis is an important opportunistic infection in endemic areas. Multiple OIs may be present in patient presenting late for HIV infection. Clinical symptoms should be monitored carefully and evaluated together with results of radiologic, microbiological and molecular tests to detect and treat multiple OIs as early as possible.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA