Navigating the Dual Threat: Cryptococcal and Tubercular Co-infections in PLHIV

Abstract

Co-infections of Cryptococcosis and tuberculosis (TB) represent a significant clinical challenge, particularly in people living with HIV, due to their compounded impact on an already compromised immune system. Cryptococcus neoformans and Mycobacterium tuberculosis exploit immune dysfunction, often resulting in severe, disseminated infections with overlapping clinical symptoms, which complicates diagnosis and delays appropriate treatment. A 55-year-old HIV-positive male, recently initiated on ART (TLD regimen) was admitted with fever, headache, vomiting, irritability, and altered behavior. Poor adherence to ART and a CD4 count of 210 cells/cumm raised concerns about a CNS opportunistic infection, possibly cryptococcal meningitis and immune reconstitution inflammatory syndrome (IRIS). Examination revealed fever, irritability, neck stiffness, and positive Kernig's signs. Cryptococcal antigen was positive, and imaging suggested both cryptococcal and tubercular meningitis. Bronchoalveolar lavage confirmed tuberculosis. The patient was treated with liposomal amphotericin B, fluconazole, and rifampicin-sparing antitubercular therapy. After showing clinical improvement, he was discharged with dual therapy and stabilized after 3 weeks of hospitalization. Our findings emphasize the importance of comprehensive clinical guidelines and multidisciplinary management to address the complexities of treating this co-infection. Our case review underscores the need for integrated