Co-infection by Pneumocystis jirovecii, cytomegalovirus and Pseudomonas aeruginosa in an HIV-infected patient in Bamako, Mali

Abstract

Pulmonary opportunistic infections remain an important cause of morbidity and mortality in AIDS. Here, we report a case of opportunistic pulmonary co-infection in HIV. A 43-year-old woman admitted in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako for progressive cough and dyspnea. She was not on antiretroviral treatment. Her initial CD4+ lymphocyte count was 17 cells/mm3 and her initial HIV-1 viral load was 1,218,000,000 copies/mL. Chest CT scan showed diffuse bilateral ground-glass opacities. PCR of Pneumocystis jirovecii DNA and cytomegalovirus DNA on tracheal aspiration fluid was positive. Bacteriological examination isolated Pseudomonas aeruginosa. Under treatment, the evolution was unfavourable and the patient died 32 days after hospitalization. The main factors associated with poor prognosis were massive lung involvement and the severe cellular immunosuppression. Early diagnosis and treatment of opportunistic infections are essential to reduce mortality in HIV infected patients