Abstract
BackgroundRhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people. In the context of HIV infection, R.equi infection (rhodococcosis) is regarded as an opportunistic disease, and its outcome is influenced by highly active antiretroviral therapy (HAART).Case presentationWe report two cases of HIV-related rhodococcosis that disseminated despite suppressive HAART and anti-rhodococcal treatment; in both cases there was no immunological recovery, with CD4+ cells count below 200/μL. In the first case, pulmonary rhodococcosis presented 6 months after initiation of HAART, and was followed by an extracerebral intracranial and a cerebral rhodococcal abscess 1 and 8 months, respectively, after onset of pulmonary infection. The second case was characterized by a protracted course with spread of infection to various organs, including subcutaneous tissue, skin, colon and other intra-abdominal tissues, and central nervous system; the spread started 4 years after clinical resolution of a first pulmonary manifestation and progressed over a period of 2 years.ConclusionsOur report highlights the importance of an effective immune recovery, despite fully suppressive HAART, along with anti-rhodococcal therapy, in order to clear rhodococcal infection.
Highlights
Rhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which is widespread in the soil and causes pulmonary and extrapulmonary infections in immunocompromised people
Our report highlights the importance of an effective immune recovery, despite fully suppressive highly active antiretroviral therapy (HAART), along with anti-rhodococcal therapy, in order to clear rhodococcal infection
Rhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which was first isolated from suppurative pulmonary lesions in foals [1]
Summary
Rhodococcus equi (R.equi) is an acid fast, GRAM + coccobacillus, which was first isolated from suppurative pulmonary lesions in foals [1]. Case report 1 In April 2002 a 49 year-old HIV-infected woman was admitted to hospital for persistent fever above 38°C and cough (Table 1) She had started HAART with didanosine, lamivudine and indinavir in October 2001,when her CD4+ cells count was 118/μL, and 2 months later had developed brain and brain stem vasculitis-like contrast-enhancing, white matter lesions, consistent with immune reconstitution central nervous system (CNS) manifestations, for which she did not receive any treatment. In November, antibiotic treatment was switched to imipenem and amikacin, whilw HAART was modified with atazanavir replaced by darunavir/ritonavir, followed by significant clinical improvement and reduction of both dimension and metabolic activity of the thigh lesion and abdominal lymph nodes, as documented by conventional CT and 18-FDG PET/CT scans. MRI follow-up showed progressive reduction of cerebral lesions, despite occurrence of seizures in December 2010, for which antiepileptic therapy was started
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
