1609. Dual Disseminated Fungal Infections with Histoplasma capsulatum and Cryptococcus neoformans in Patients with AIDS
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Background: Cryptococcosis (C) and histoplasmosis (H) are common infections in patients with AIDS. Concomitant infections with both pathogens have rarely been reported. Our recent encounters with 6 patients with AIDS and simultaneous H and C presented therapeutic challenges in the choice of azole maintenance therapy.

Methods: Patients were identified via encounters in our practice and through discharge diagnoses. Cases were reviewed for demographics, findings on laboratory examinations, and treatment.

Results:

Patient→

1

2

3

4

5

6

Beta-D-glucan

NA

NA

>500

NA

75

>500

Urine histo antigen

16.22

7.37

1.72

7.37

25

>19

Serum crypto antigen

1:256

NA

1:2

1:32

1:4

1:32

CSF

18 WBC (all lymphs)

Glu 41

Prot 99

Crypto Antigen 1:256

Culture - crypto

34 WBC (all lymphs)

Glu 34

Prot 194

Crypto Antigen 1:8

Culture - crypto

100 WBC (all lymphs)

Glu 31

Prot 151

Crypto Antigen not done

Cultures NA

34 WBC (69% lymphs)

Glu 34

Prot 194

Crypto Antigen 1:8

Cultures neg

0 WBC

Glu 51

Prot 84

Crypto Antigen neg

Cultures neg

0 WBC

Glu 31

Prot 57

Crypto Antigen neg

Cultures neg

Blood cultures

Histo

Histo and crypto

Neg

Neg

Neg

Neg

Liposomal ampho B

5 mg/kg x 14 days

5 mg/kg x 14 days

NA

5 mg/kg daily (plus 5-flucytosine) for 13 days

3 mg/kg daily x 7 days

3 mg/kg daily x 3 days

Azole

Itraconazole 200 mg BID

Fluconazole 400 mg daily

Fluconazole 400 mg daily then itraconazole 200 mg BID

Fluconazole 400 mg po daily

Itraconazole 200 mg BID

Voriconazole 200 mg BID

Combination ART

No

No

Yes

No

No

No

Follow-up

NA

Doing well at 6 months of follow-up

Receiving chemotherapy for Burkitt Lymphoma for 9 months

Discharged for hospice care

Await follow-up

Discharged for hospice care

Conclusion: Although C and H are common causes of disseminated fungal infections in AIDS patients, few reports illustrate the co-existence of these infections in a single patient. Although both fungal infections are usually treated with long-term azole administration, different azoles are recommended. The choice of azole treatment when both infections are present simultaneously, as well as other therapeutic challenges present in this population, can make management decisions difficult. More recognition and reporting of dual fungal infections in this population, including the use of newer azole agents, hopefully will provide guidance for future treatment.

Michael Gelfand, MD and Kerry Cleveland, MD, Medicine/Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN

Disclosures:

M. Gelfand, Astellas Pharmaceuticals: Speaker's Bureau , Speaker honorarium

K. Cleveland, None

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