CLINICAL AND EPIDEMIOLOGICAL STUDY Cryptococcosis and tuberculosis co-infection at a university hospital in Taiwan, 1993–2006 C.-T. Huang • Y.-J. Tsai • J.-Y. Fan • S.-C. Ku • C.-J. Yu Received: 28 June 2010 / Accepted: 5 July 2010 / Published online: 27 July 2010 Ó Urban & Vogel 2010 Abstract Background The human immunodeficiency virus (HIV) epidemic and increasing use of immunosuppressive agents have increased the prevalence of both cryptococcosis and tuberculosis (TB). However, the status of co-infection with both pathogens remains unknown. Methods This study retrospectively reviewed patient records of cryptococcosis and TB co-infection from 1993 to 2006. The temporal sequence of co-infection was defined as either concurrent or sequential. Data collected included patient demographics, HIV status, co-morbidities, clinical manifestations, treatment strategies, and outcome at 1-year follow-up. Results There were 23 patients with cryptococcosis and TB co-infection, representing 5.4% of cryptococcosis or 0.6% of TB cases. Eleven (48%) patients were HIV-infected, and no underlying disease or immunocompromised state could be identified in six (26%) patients. Twelve (52%) patients presented with concurrent infection, but diagnosis of co-infection could be achieved simultaneously in only three (13%). Constitutional symptoms, particularly fever and weight loss, were the most common presenting symptoms, developing in more than two-thirds of the patients. The majority (83%) of the patients made a good recovery fol- lowing dual antifungal and anti-TB therapy. There were three mortalities at the 1-year follow-up, which might be attributable to a delay in diagnosis and treatment of co-infection. The outcomes of HIV-infected and non- HIV-infected patients were not significantly different. Conclusions Cryptococcosis and TB co-infection, although rare, develops in both immunocompromised and healthy individuals. Early diagnosis and treatment may improve patient prognosis. There should be a high index of suspicion in order to achieve a timely diagnosis in a TB endemic area. Keywords Co-infection Á Cryptococcosis Á Human immunodeficiency virus Á Tuberculosis Introduction With the emergence of human immunodeficiency virus (HIV) epidemic and the widespread use of potent immu- nosuppressives in organ transplant recipients, there are increasing number of patients acquiring either cryptococ- cosis or tuberculosis (TB) due to impaired cellular immu- nity [1, 2]. Both diseases are granulomatous infections, with the former caused by Cryptococcus neoformans and the latter by Mycobacterium tuberculosis, and both have characteristics in common in terms of endemicity, includ- ing Southeast Asia, and clinical manifestations. They can develop across the whole spectrum of patient populations, from the apparently immunocompetent hosts to those severely immunocompromised [3, 4]. However, to the best C.-T. Huang Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Br., Yunlin, Taiwan S.-C. Ku (&) Á C.-J. Yu Department of Internal Medicine, National Taiwan University Hospital, # 7 Chung-Shan South Road, Taipei 100, Taiwan e-mail: scku1015@ntu.edu.tw Y.-J. Tsai School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan J.-Y. Fan Department of Nursing, Chang Gung Institute of Technology, Tao-Yuan, Taiwan Infection (2010) 38:373–379 DOI 10.1007/s15010-010-0045-9