Status of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara University Teaching Hospital in Southwestern Uganda

Abstract

Background: Pulmonary mycoses are important diseases of the respiratory tract caused by pulmonary fungal pathogens. These pathogens are responsible for significant morbidity and mortality rates worldwide; however, less attention has been paid to them. In this study we determined the prevalence of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara Regional Referral Hospital. Method: This was a hospital based cross sectional survey. Sputum samples were collected from each study participant. For each sample, the following tests were performed: Sabouraud dextrose agar for fungal culture, GeneXpert for Mycobacteria tuberculosis (MTB) and potassium hydroxide for fungal screening. Filamentous fungal growth and yeasts were further examined with lactophenol cotton blue staining and germ tube respectively. Results: Out of 113 study participants, 80 (70.7%) had pulmonary fungal pathogens whilst those with pulmonary tuberculosis numbered five (4.4%). Candida albicans [21 (22.58%)] and Aspergillus species [16 (17.20%)] were the pathogens most identified among others. Two (1.7%) TB GeneXpert positive participants had fungal pathogens isolated from their sputum samples. We established a prevalence of 57 (71.3%) for pulmonary fungal pathogen (PFP) isolates, three (60.0%) for MTB in HIV positive patients and 18 (22.5%) for PFP, and zero (0.0%) for MTB in HIV negative patients. On the other hand, two (100%) HIV positive patients had both PFP isolates and MTB. Conclusion: Our findings highlight the diversity of neglected pulmonary fungal pathogens whose known medical importance in causing pulmonary mycoses cannot be overemphasised. Therefore this presents a need for routine diagnosis for pulmonary mycoses among TB suspects and set-up of antimicrobial profile for pulmonary fungal isolates to support clinical management of these cases.

Re-estimation of the burden of serious fungal diseases in Uganda

“…A. niger , but additional diagnostic work-up with imaging and antibody detection is required to diagnose aspergillosis. 105 , 106 Other factors such as COPD, recurrent pneumonias, and cavities caused by other infectious diseases such as echinococcosis and nocardiosis also contribute to CPA burden, 104 but are probably accounted for among the smear or GeneXpert-negative cases in Uganda, given the general lack of other diagnostics.…”

Necrotising pneumonia caused by Curvularia hawaiiensis (syn. Bipolaris hawaiiensis) and Mycobacterium tuberculosis coinfection in a patient with ascariasis: a case report and review

“…1 b), contact with TB was likely prolonged. And according to some reports, active TB becomes a risk factor for fungal infections in certain previously healthy patients [ 8 , 10 ].…”

Relationship Between Invasive Fungal Infection and Hypostatic Pneumonia: A Prospective Cohort Study

“…Invasive fungal infection (IFI) refers to the invasion of organ tissue, blood, or other sterile body sites by fungi ( Webb et al, 2018 ). Lung is one of the main target organs of IFIs ( Luo et al, 2010 ), with symptoms such as cough, fever, hemoptysis, and dyspnea, similar to bacterial pneumonia ( Luo et al, 2010 ; Dion and Ashurst, 2021 ; Njovu et al, 2021 ). Pulmonary mycosis is self-limiting generally, but several patients will evolve to develop acute or chronic infection ( Di Mango et al, 2019 ).…”