Abstract
BackgroundWe screened patients with chronic respiratory diseases for microbiological and serological evidences of fungal colonisation; in order to determine its prevalence in this group of patients, examine potential clinical and radiological predictors of fungal colonisation and characterise fungal agents associated with individual diseases.MethodsBAL samples from 60 consecutive patients were subjected to microscopy and culture for fungal agents. Serum samples were analysed for precipitin antibodies to Aspergillus antigen and Candida cytoplasmic antigen. Statistical significance in the difference of fungal recovery between patient groups was determined using the Chi-square test.ResultsThe major diagnostic groups included patients with bronchogenic carcinoma (n = 31) and tubercular sequelae (n = 16). In all, 28 patients (46.7%) were culture-positive, with Candida and Aspergillus being recovered from 14 and 13 patients respectively. Twenty-one patients (35%) showed presence of precipitin antibodies. Patients with bronchogenic carcinoma showed increased predilection for colonisation with Aspergillus, while Candida was recovered more commonly in tubercular sequelae (p = 0.02). There was no statistically significant association between culture-positivity and specific risk factors/radiological findings.ConclusionThe point-prevalence of fungal colonization was almost 50%. The combination of fungal culture and serology helped improve diagnostic sensitivity. An interesting predilection was observed for Aspergillus and Candida, to preferentially infect patients with Bronchogenic carcinoma and Tubercular sequelae respectively. In absence of specific predictors, the possibility of fungal colonization needs to be explored actively in these patients.
Highlights
We screened patients with chronic respiratory diseases for microbiological and serological evidences of fungal colonisation; in order to determine its prevalence in this group of patients, examine potential clinical and radiological predictors of fungal colonisation and characterise fungal agents associated with individual diseases
In this study we report the profile of fungal colonization of the respiratory tract in patients presenting with different chronic respiratory conditions in a tertiary care teaching hospital located in the Himalayan region of India
The identity of the fungi recovered was different between the major diagnostic categories with significant predilection being observed for colonisation with Aspergillus sp. in patients suffering from Bronchogenic carcinoma and for Candida sp. among patients with Tubercular sequelae
Summary
We screened patients with chronic respiratory diseases for microbiological and serological evidences of fungal colonisation; in order to determine its prevalence in this group of patients, examine potential clinical and radiological predictors of fungal colonisation and characterise fungal agents associated with individual diseases. Fungal infections have emerged as a world-wide health care problem in recent years [1], owing to the extensive use of broad-spectrum antibiotics [2], long-term use of immunosuppressive agents, increasing use of hyperalimentation and indwelling devices [3] and the increasing population of terminally ill, debilitated and immunocompromised patients [4]. In tune with this general trend, there has been a phenomenal rise in the occurrence of fungal lung infections over the last two decades [5], a significant fraction of which is communityacquired [1]. The present study was designed with the purpose of characterizing the fungal pathogens associated with particular pulmonary diseases, and correlating between the individual fungal pathogens and the profile of risk factors, radiological presentations and clinical conditions in these patients
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