Abstract
ObjectivesAspergillus and Mycobacterium are opportunistic pathogens that can cause severe pulmonary diseases. To date, the clinical significance of their concomitant isolation and potential interactions in the lung remains poorly understood. The aim of this study was to assess the prevalence of their concomitant isolation from respiratory samples, and to depict the related clinical and microbiological characteristics.MethodsA retrospective monocentric study was conducted from January 2011 to December 2017, including all in-patients from whom positive cultures of Aspergillus and Mycobacterium were obtained on respiratory samples within a 3-month period. Clinical, radiological and laboratory data were analyzed. Patients were categorized by a clinical and microbiological committee as “infected” or “colonized” by both pathogens according to current guidelines.ResultsOverall, 140 patients had ≥1 respiratory samples positive for Mycobacterium and concomitantly sent for fungal culture, and 708 were positive for Aspergillus, concomitantly sent for mycobacterial culture. Only 50 had at least one positive culture for both Mycobacterium sp. and Aspergillus sp. Men represented 63% of patients, mean age was 61 years. A third of patients were immunocompromised and 92% had underlying lung diseases. Aspergillus was primarily found as a colonizing agent. Proportion of Mycobacterium Avium Complex (p = 0.02) was higher in patients co-carrying Aspergillus spp.ConclusionIn this first study focusing on co-isolation of Mycobacteria and Aspergillus in patient’s respiratory samples, co-infection remains rare. Further studies are warranted in order to precise the exact relationship between these opportunistic pathogens and the clinical impact of co-isolations.
Highlights
Mycobacteria are commonly divided into Mycobacterium tuberculosis complex, which causes tuberculosis (TB), and nontuberculous Mycobacteria (NTM), which cause opportunistic lung diseases in patients with pre-existing pulmonary disease and/or mild to severe immunosuppression
Hypersensitivity to Aspergillus fumigatus can lead to another form of aspergillosis called allergic broncho-pulmonary aspergillosis (ABPA) (Agarwal et al, 2013)
140/488 (28.7%) patients had their Mycobacteria-positive sample concomitantly sent to the mycology department for culture, and 708/896 (79%) had their Aspergillus-positive sample concomitantly searched for Mycobacteria
Summary
Mycobacteria are commonly divided into Mycobacterium tuberculosis complex, which causes tuberculosis (TB), and nontuberculous Mycobacteria (NTM), which cause opportunistic lung diseases in patients with pre-existing pulmonary disease and/or mild to severe immunosuppression. Unlike TB, the detection of NTM in pulmonary specimen does not always denote the disease itself since NTM are common environmental germs. Aspergillus is a ubiquitous mold that causes invasive pulmonary aspergillosis (IPA) and various clinical and radiological forms of chronic pulmonary aspergillosis (CPA) in patients with pre-existing pulmonary diseases (Kousha et al, 2011). CPA like simple pulmonary aspergilloma (SPA), chronic cavitary pulmonary aspergillosis (CCPA), and subacute invasive aspergillosis (or necrotizing CPA) are associated with different degrees of lung damage (Denning et al, 2016). Hypersensitivity to Aspergillus fumigatus can lead to another form of aspergillosis called allergic broncho-pulmonary aspergillosis (ABPA) (Agarwal et al, 2013)
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