Renal microsporidiosis due to Encephalitozoon cuniculi in an HIV/AIDS patient with persistent fever and kidney injury

In individuals with HIV/AIDS, 47% of the deaths are attributed to invasive fungal infections (IFIs), despite antiretroviral (ARV) therapy. This is a retrospective study carried out in the Hospital Regional de Alta Especialidad Oaxaca (HRAEO), southwest Mexico, where IFIs that occurred during 2016–2017 are described. A total of 55 individuals were included. Histoplasmosis (36%) and possible-IFIs in neutropenic fever (20%) were the most frequent cases, followed by cryptococcosis (14%). The HIV/AIDS subpopulation corresponded with 26 cases (47%), all from an indigenous origin. The incidence of IFIs among them was 24% (95% CI = 15–33%). The CD4+ T cells median was 35 cells/mL (IQR 12–58). Four cases (15%) of unmasking IRIS were identified, three of histoplasmosis and one coccidioidomycosis. Co-infections were found in 52% (12/23), and tuberculosis in 50% (6/12) was the most frequent. The mortality rate was 48%. The general characteristics of the HIV individuals who died were atypical pneumonia (70% vs. 9%, p = 0.01), acute kidney injury, (70% vs. 9%, p = 0.008) and ICU stay (80% vs. 9%, p = 0.002). In conclusion, IFIs are diagnosed in one out of four individuals with HIV/AIDS along with other complicated infectious conditions, leading to major complications and a high mortality rate.

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Continuous Renal Replacement Therapy in patients with HIV/AIDS

10.21203/rs.2.20631/v3 ◽

2020 ◽

Author(s):

Hebing Guo ◽

Jingyuan Liu ◽

Lin Pu ◽

Jingjing Hao ◽

Ningning Yin ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Influence Factors ◽

Kidney Injury ◽

Intermittent Hemodialysis ◽

Retrospective Case ◽

Mechanical Ventilation Duration ◽

Study Results ◽

Hiv Aids

Abstract Background: Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis. Methods: We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study. Results: 122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR=7.333,95% CI 1.467-36.664, p=0.015), higher likelihood of diagnosis for septic shock (OR=1.005,95% CI 1.001-1.01, p=0.018), and higher likelihood to use vasoactive agents (OR=10.667,95% CI 1.743-65.271, p=0.001), longer mechanical ventilation duration (OR=1.011,95% CI 1.002-1.019, p=0.011), higher likelihood for diagnosis for PCP (OR=7.50,95% CI 1.288-43.687, p=0.025), higher SOFA score at ICU admission (OR=1.183,95% CI 1.012-1.383, p=0.035), longer duration of CRRT (OR=1.014,95% CI 1.001-1.028, p=0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p =0.595).Conclusion: There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.

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