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VOLUME 15 , ISSUE 2 ( February, 2024 ) > List of Articles

CASE REPORT

Coronavirus Disease 2019, Mucormycosis, and Pulmonary Tuberculosis in Human Immunodeficiency Virus-positive Patient: A Rare Case Report and Review of Literature

Dinraj Kulkarni, Dhriti Garde, Sachin Sarode, Aliya Khan, Janardhan Garde, Apurva Naik

Keywords : Case report, Coinfection, Human immunodeficiency virus, Severe acute respiratory syndrome coronavirus 2, Mucormycosis, Mycobacterium Tuberculosis

Citation Information : Kulkarni D, Garde D, Sarode S, Khan A, Garde J, Naik A. Coronavirus Disease 2019, Mucormycosis, and Pulmonary Tuberculosis in Human Immunodeficiency Virus-positive Patient: A Rare Case Report and Review of Literature. World J Dent 2024; 15 (2):174-180.

DOI: 10.5005/jp-journals-10015-2381

License: CC BY-NC 4.0

Published Online: 02-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and objective: This case report represents an extremely rare event of coinfection associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Mucormycosis, and Mycobacterium tuberculosis (MTB) in human immunodeficiency virus (HIV)-positive patients. Background: This case report suggests that the patient suffered from quadruple infections like HIV, MTB, coronavirus disease 2019 (COVID-19), and mucormycosis. Case description: A 41-year-old patient with a known history of HIV/acquired immunodeficiency syndrome (AIDS) was hospitalized with an 8 days history of fever, tiredness, sore throat, anosmia, myalgia, headache, shortness of breath, and cough with hemoptoic sputum. To confirm the diagnosis, the patient underwent laboratory and diagnostic tests in the form of reverse transcription polymerase chain reaction (RT-PCR) with a high-resolution computed tomography (HRCT) score of 16/25, D-dimer and C-reactive protein (CRP) for COVID-19, Monteux test, and gene expert test for MTB, complete blood count showing leukocytosis and monocytosis, erythrocyte sedimentation rate (ESR) found to be 41, cluster of differentiation 4 (CD4) count was 340 cells mm3, and HIV-1 RNA level was 9000 copies/mL to confirm HIV positivity. After 10 days of admission, the patient started with dull, aching pain in the upper right posterior region of the oral cavity, which worsened in due course due to the presentation of numbness in the malar region area and the mobility of the teeth. Diagnostic tests in the form of CT of paranasal sinuses (PNS), CT brain, and orbit were performed, suggestive of suspected invasive fungal infection. To confirm the diagnosis, a biopsy was taken and sent for histopathological diagnosis, and the report suggested that it was mucormycosis. Conclusion and clinical significance: Despite quadruple coinfections, the patient survived and recovered from complications. Further diagnosis and investigations for mucormycosis, MTB, and HIV/AIDS should be carried out for all the patients admitted to the COVID-19 ward due to their similar and nonspecific clinical manifestations.


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  1. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579(7798):270–273. DOI: 10.1038/s41586-020-2012-7
  2. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. New Eng J Med 2020;382(8):727–733. DOI: 10.1056/NEJMoa2001017
  3. COVID-19 cases, recoveries and deaths worldwide 2023 [Internet]. Statista. [Cited 2024 Jan 20].
  4. Mohfw.gov.in./COVID-19. Accessed October 2022
  5. Tsai PH, Lai WY, Lin YY, et al. Clinical manifestation and disease progression in COVID-19 infection. J Chin Med Assoc 2021;84(1):3–8. DOI: 10.1097/JCMA.0000000000000463
  6. Adhikari SP, Meng S, Wu YJ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Pov 2020;9(1):29. DOI: 10.1186/s40249-020-00646-x
  7. Härter G, Spinner CD, Roider J, et al. COVID-19 in people living with human immunodeficiency virus: a case series of 33 patients. Infection 2020;48(5):681–686. DOI: 10.1007/s15010-020-01438-z
  8. World Health Organization. Coronavirus. Available from: https://www.who.int/health-topics/coronavirus#tab=tab_1. Accessed August 25, 2021. 2020.
  9. Mucormycosis [Internet]. NORD (National Organization for Rare Disorders). Available from: https://rarediseases.org/rare-diseases/mucormucosis/2024
  10. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000;13(2):236–301. DOI: 10.1128/CMR.13.2.236
  11. Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev 2005;18(3):556–569. DOI: 10.1128/CMR.18.3.556-569.2005
  12. Nagarakanti SR, Okoh AK, Grinberg S, et al. Clinical outcomes of patients with COVID-19 and HIV coinfection. J Med Virol 2021;93(3):1687–1693. DOI: 10.1002/jmv.26533
  13. Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet infect dis 2019;19(12):e405–e421. DOI: 10.1016/S1473-3099(19)30312-3
  14. Lamoth F, Chung SJ, Damonti L, et al. Changing epidemiology of invasive mold infections in patients receiving azole prophylaxis. Clin Infect Dis 2017;64(11):1619–1621. DOI: 10.1093/cid/cix130
  15. Jenks JD, Reed SL, Seidel D, et al. Rare mould infections caused by Mucorales, Lomentospora prolificans and Fusarium, in San Diego, CA: the role of antifungal combination therapy. Int J Antimicrob Agents 2018;52(5):706–712. DOI: 10.1016/j.ijantimicag.2018.08.005
  16. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239–1242. DOI: 10.1001/jama.2020.2648
  17. RECOVERY Collaborative Group; Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med 2021;384(8):693–704. DOI: 10.1056/NEJMoa2021436
  18. Arastehfar A, Carvalho A, van de Veerdonk FL, et al. COVID-19 associated pulmonary aspergillosis (CAPA)—from immunology to treatment. J Fungi 2020;6(2):91. DOI: 10.3390/jof6020091
  19. Vujkovic-Cvijin I, Dunham RM, Iwai S, et al. Dysbiosis of the gut microbiota is associated with HIV disease progression and tryptophan catabolism. Sci Transl Med 2013;5(193):193ra91. DOI: 10.1126/scitranslmed.3006438
  20. World Health Organization. Global tuberculosis control: surveillance, planning, financing: WHO report 2008. World Health Organization 2008.
  21. Pawlowski A, Jansson M, Sköld M, et al. Tuberculosis and HIV coinfection. PLoS Pathog 2012;8(2):e1002464. DOI: 10.1371/journal.ppat.1002464
  22. Joint United Nations Programme on HIV/AIDS. Global AIDS Update: Miles to Go. UNAIDS. Geneva, Switzerland (2018).
  23. UNAIDS. Global HIV& AIDS statistics – 2019 fact sheet. (2019). www.unaids.org/en/resources/fact-sheet.
  24. Farias LA, Moreira AL, Corrêa EA, et al. Case report: coronavirus disease and pulmonary tuberculosis in patients with human immunodeficiency virus: report of two cases. Am J Trop Med Hyg 2020;103(4):1593. DOI: 10.4269/ajtmh.20-0737
  25. WHO. World Health Organization. Global tuberculosis report 2019.
  26. Glynn JR. Resurgence of tuberculosis and the impact of HIV infection. Br Med Bull 1998;54(3):579–593. DOI: 10.1093/oxfordjournals.bmb.a011712
  27. Kwan CK, Ernst JD. HIV and tuberculosis: a deadly human syndemic. Clin Microbiol Rev 2011;24(2):351–376. DOI: 10.1128/CMR.00042-10
  28. WHO. (2010) treatment of Tuberculosis: Guidelines World Health Organization.
  29. Tamuzi JL, Ayele BT, Shumba CS, et al. Implications of COVID-19 in high burden countries for HIV/TB: a systematic review of evidence. BMC Infect Dis 2020;20(1):744. DOI: 10.1186/s12879-020-05450-4
  30. Patel KB, Belmonte R, Crowe HM. Drug malabsorption and resistant tuberculosis in HIV-infected patients. New Engl J Med 1995;332(5):336–337. DOI: 10.1056/NEJM199502023320518
  31. Suchindran S, Brouwer ES, Van Rie A. Is HIV infection a risk factor for multi-drug resistant tuberculosis? A systematic review. PloS One 2009;4(5):e5561. DOI: 10.1371/journal.pone.0005561
  32. Narita M, Stambaugh JJ, Hollender ES, et al. Use of rifabutin with protease inhibitors for human immunodeficiency virus-infected patients with tuberculosis. Clin Infect Dis 2000;30(5):779–783. DOI: 10.1086/313771
  33. Coronavirus disease (COVID-19) pandemic. World Health Organization, 2020 (available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019)
  34. Country & technical guidance -Coronavirus disease (COVID-19) pandemic. World Health Organization, 2020.
  35. Gudipati, S, Brar I, Murray S, et al. Descriptive analysis of patients living with HIV affected by COVID-19. J Acquir Immune Defic Syndr 2020;85(2):123–126. DOI: 10.1097/QAI.0000000000002450
  36. Mirzaei H, McFarland W, Karamouzian M, et al. COVID-19 among people living with HIV: a systematic review. AIDS Behav 2021;25(1):85–92. DOI: 10.1007/s10461-020-02983-2
  37. Singh AK, Singh R, Joshi SR, et al. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes Metab Syndr 2021;15(4):102146. DOI: 10.1016/j.dsx.2021.05.019
  38. Palanisamy PR, Elango D. COVID-19 associated mucormycosis: a review. J Fam Med Prima Care 2022;11(2):418–423. DOI: 10.4103/jfmpc.jfmpc_1186_21
  39. Rivas N, Espinoza M, Loban A, et al. Case report: COVID-19 recovery from triple infection with Mycobacterium tuberculosis, HIV, and COVID-19. Am J Trop Med Hyg 2020;103(4):1597–1599. DOI: 10.4269/ajtmh.20-0756
  40. Tolossa T, Tsegaye R, Shiferaw S, et al. Survival from a triple coinfection of COVID-19, HIV, and tuberculosis: a case report. Int Med Case Rep J 2021;14:611–615. DOI: 10.2147/IMCRJ.S326383
  41. Chen Y, Wang Y, Fleming J, et al. Active or latent tuberculosis increases susceptibility to COVID-19 and disease severity. MedRxiv 2020. DOI: 10.1101/2020.03.10.20033795
  42. Blanco JL, Ambrosioni J, Garcia F, et al. COVID-19 in patients with HIV: clinical case series. Lancet HIV 2020;7(5):e314–e316. DOI: 10.1016/S2352-3018(20)30111-9
  43. Gervasoni C, Meraviglia P, Riva A, et al. Clinical features and outcomes of HIV patients with coronavirus disease 2019. Clin Infect Dis 2020;71(16):2276–2278. DOI: 10.1093/cid/ciaa579
  44. Motta I, Centis R, D'Ambrosio L, et al. Tuberculosis, COVID-19 and migrants: preliminary analysis of deaths occurring in 69 patients from two cohorts. Pulmonology 2020;26(4):233–240. DOI: 10.1016/j.pulmoe.2020.05.002
  45. He G, Wu J, Shi J, et al. COVID-19 in tuberculosis patients: a report of three cases. J Med Virol 2020;92(10):1802–1806. DOI: 10.1002/jmv.25943
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