Case Report

Multiple opportunistic infections (pulmonary tuberculosis, Mycobacterium avium complex and parvovirus B19) in a single patient

Midhun T. John, Michelle Venter, Jenifer Vaughan, Marianne Black, Daniel Prince, Aishwarya M. Luke, Mithra John
Southern African Journal of HIV Medicine | Vol 23, No 1 | a1319 | DOI: https://doi.org/10.4102/sajhivmed.v23i1.1319 | © 2022 Midhun T. John, Michelle Venter, Jenifer Vaughan, Marianne Black, Daniel Prince, Aishwarya M. Luke, Mithra John | This work is licensed under CC Attribution 4.0
Submitted: 21 September 2021 | Published: 25 January 2022

About the author(s)

Midhun T. John, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Michelle Venter, Department of Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Jenifer Vaughan, Department of Clinical Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Marianne Black, Department of Microbiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Daniel Prince, Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Aishwarya M. Luke, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Mithra John, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa


Share this article

Bookmark and Share

Abstract

Introduction: HIV infection is a common disease in the South African population. The virus can lead to the development of many opportunistic infections. This case study examines co-infection with three opportunistic infections and the need for clinical suspicion of infections in our HIV population.

Patient presentation: A 36-year-old unemployed female residing in Soweto, Johannesburg, presented at Chris Hani Baragwanath Hospital (CHBAH). She was HIV positive, defaulting treatment, with no other comorbidities. She presented to CHBAH with general body weakness, diarrhoea, cough and constitutional symptoms; clinically she appeared pale and chronically ill. A differential diagnosis was made of multiple infections co-inhabiting the patient.

Management and outcome: The patient had blood, sputum, radiological and invasive bone marrow aspiration, and trephine biopsies completed. The investigations revealed that she was co-infected with Mycobacterium tuberculosis (MTB), Mycobacterium avium complex (MAC) and parvovirus B19. The TB and disseminated MAC infection were managed with rifampicin, isoniazid, ethambutol, pyrazinamide and azithromycin, and reinitiation of antiretroviral (ARV) treatment was planned on further follow-up of the ARV drug resistance test. The parvovirus B19 infection was managed with immunoglobulins (Polygam) and steroids (prednisone). She was discharged successfully for further follow-up.

Conclusion: A thorough history, clinical examination and subsequent targeted investigations are vital to arriving at the correct diagnosis or diagnoses. The case presented above serves to illustrate how three life-threatening opportunistic infections (OIs), all with differing treatments, may present in a single patient. Clinicians caring for immunosuppressed patients need to remain vigilant for the presence of multiple OIs occurring simultaneously.


Keywords

MAC; parvovirus B19; tuberculosis; HIV; multiple organisms

Metrics

Total abstract views: 1059
Total article views: 1041


Crossref Citations

No related citations found.