Role of Comorbidities in Acquiring Pulmonary Fungal Infection in COPD Patients

Abstract

To assess the role, risk factors and outcome of different comorbidities in acquiring pulmonary fungal infection among COPD patients. METHODS: In this prospective cross-sectional analytic study, different samples (sputum, bronchoalveolar lavage (BAL), and blood) from 177 COPD admitted to tertiary university hospital, were examined for fungal infection using direct microscopy and culture. BAL and serum samples were examined by Human (1-3)-b-D-glucan (1,3BDG) and Galactomannan (GM) ELISA tests. RESULTS: Pulmonary fungal infection was confirmed in (77.8%) out of COPD patients with comorbidities versus (53.1%) in COPD patients without comorbidities (53.1%) (P< 0.001) with predominance of candida and aspergillus spp., in both groups. Serum GM was positive in 16 (19.7%) COPD patients with comorbidities versus 7 (7 .3%) in COPD patients without comorbidities (P¼0.02). BAL GM had a higher diagnostic yield in comparison to serum GM and 1,3BDG. There was no significant association between culture-positivity and radiological findings. Mechanical ventilation, corticosteroid therapy, ICU admission and age were the major risk factors for pulmonary fungal infection in COPD patients with comorbiditi es (P ¼ 0.012; ODR¼2.23, P ¼ 0.028; ODR¼1.99, P ¼ 0.025; ODR¼1.94, P ¼ 0.034; respectively).COPD patients with comorbidities had significantly higher mortality rate (12.3%) than COPD patients without comorbidities (3.1%) (P¼0.01). CONCLUSIONS: COPD patients with comorbidities had higher prevalence of pulmonary fungal infection and higher mortality rate than COPD patients without comorbidities. Age, mechanical ventilation, corticosteroids therapy and ICU admission were independently risk factors for pulmonary fungal infection in COPD patients with comorbidities. CLINICAL IMPLICATIONS: Comorbities are risk factors for acquiring pulmonary fungal infection in COPD patients and is associated with higher mortality rate.

Analysis of bacterial spectrum, activin A, and CD64 in chronic obstructive pulmonary disease patients complicated with pulmonary infections

“…COPD often occurs in the elderly, due to multiple underlying diseases, weak cough reflex, and low immune function. This ultimately leads to high incidences of pulmonary infections[ 1 , 2 ]. This study found that pulmonary infections in COPD patients are mainly caused by Gram-negative bacteria like Klebsiella pneumoniae and Pseudomonas aeruginosa .…”

“…COPD is often complicated by a collection of underlying diseases. This disease, coupled with poor nutrition and immunologic function, can often lead to a high incidence in pulmonary infections[ 1 , 2 ]. In turn, pulmonary infections can worsen COPD and promote acute exacerbations of COPD (AECOPD), which further aggravates patient prognosis.…”

“…In turn, pulmonary infections can worsen COPD and promote acute exacerbations of COPD (AECOPD), which further aggravates patient prognosis. This is the main cause of death in COPD patients[ 1 , 3 ].…”