A CASE OF AN HIV- POSITIVE PATIENT CO-INFECTED WITH MULTIDRUG-RESISTANT TUBERCULOSIS

Abstract

Tuberculosis has a greater impact on morbidity and mortality in HIV-1-infected individuals than the rest of the opportunistic infections. We report a case of 57-year-old HIV-infected patient co-infected with multidrug- resistant tuberculosis (MDR-TB). The patient`s leading clinical syndromes were fever, diarrhoea and weight loss. The meticulously performed laboratory investigations revealed severe immune suppression and high HIV viral load. Microbiological and parasitological tests confirmed the presence of two AIDS-defining conditions: disseminated candidiasis and cryptosporidiosis. Sputum smear microscopy for acid-fast bacilli was negative but sputum culture showed positive result for Mycobacterium tuberculosis. Drug susceptibility testing determined resistance to isoniazid and rifampicin (MDR-TB). The diagnosis was confirmed with Xpert-MTB/RIF PCR test. Treatment continued with second-line anti-TB drugs, together with antiretroviral therapy. Culture conversion was recorded in the first month. The outcome was reported as „cured“ after 16 months` therapy. This case shows yet again that the clinical manifestation of tuberculosis in HIV-infected patients is very atypical. Multidrug-resistant tuberculosis requires prolonged treatment and represents therapeutic challenge because of the possibility of adverse drug reactions.

Keywords

• HIV
• tuberculosis (TB)
• multidrug-resistant TB (MDR-TB)
• atypical presentation
• therapeutic challenge