A STUDY OF FUNGAL INFECTIONS IN CLINICALLY SUSPECTED TUBERCULOSIS PATIENTS
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i8.48673Keywords:
Respiratory tract infections, Fungal infections, Clinically suspected tuberculosis cases, Anti-tubercular drugsAbstract
Objectives: The purpose of the current study is to create awareness among the clinicians on the role of fungal etiological agents in suspected tuberculosis (TB) cases. This would help in preventing unnecessary use of anti-tubercular drugs and in decreasing drug-resistant TB cases.
Methods: Prospective study was performed in the clinical microbiology laboratory of Annapoorana Medical College and Hospital, Salem, Tamil Nadu, from January 2013 to February 2017 subsequently getting approval from the institutional ethics committee. 464 sputum samples were collected from both inpatients and outpatients of numerous departments. Signs and symptoms of clinically suspected TB patients were noted for all cases.
Statistical Analysis: Categorical variables were summarized by percentages (%). The Fishers exact test (2 × 2) analysis was done.
Results: A total of 119 fungal isolates were isolated from the culture. The highest number of fungal isolates were of Candida species (n=61) (30.5%) followed by Cryptococcus neoformans n=38 (19%) and Histoplasma capsulatum n=20 (10%). Amongst the used anti-fungals, Fluconazole was the most effective drug for all the isolated fungi followed by Itraconazole, Amphotericin B, Voriconazole, and Nystatin.
Conclusion: Our study findings indicate the significance of considering fungal infections as a prospect however treating disseminated granulomatous infections, even in immune-competent cases, particularly if the reaction to the TB therapy is insufficient.
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References
Thomas M, Bomar P, Koutsothanasis GA. Upper respiratory tract infection. In: StatPearls Treasure Island: StatPearls Publishing; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532961
Ozyilmaz E, Akan OA, Gulhan M, Ahmed K, Nagatake T. Major bacteria of community-acquired respiratory tract infections in Turkey. Jpn J Infect Dis 2005;58:50-2. PMID 15728995
Walker PA, White DA. Pulmonary disease. Med Clin North Am 1996;80:1337-62. doi: 10.1016/S0025-7125(05)70493-4
Attia EF, Pho Y, Nhem S, Sok C, By B, Phann D, et al. Tuberculosis and other bacterial co-infection in Cambodia: A single center retrospective cross-sectional study. BMC Pulm Med 2019;19:60. doi: 10.1186/ s12890-019-0828-4, PMID 30866909
Langbang A, Deka N, Rahman H, Kalita D. A study on bacterial pathogens causing secondary infections in patients suffering from tuberculosis and their pattern of antibiotic sensitivity. Int J Curr Microbiol Appl Sci 2016;5:197-203. doi: 10.20546/ijcmas.2016.508.021
Ngekeng S, Pokam BT, Meriki HD, Njunda AL, Assob JC, Ane- Anyangwe I. High prevalence of bacterial pathogens in sputum of tuberculosis suspected patients in Buea. Br Microbiol Res J 2015;11:1- 8. doi: 10.9734/BMRJ/2016/22426
Iliyasu G, Mohammad AB, Yakasai AM, Dayyab FM, Oduh J, Habib AG. Gram-negative bacilli are a major cause of secondary pneumonia in patients with pulmonary tuberculosis: Evidence from a cross-sectional study in a tertiary hospital in Nigeria. Trans R Soc Trop Med Hyg 2018;112:252-4. doi: 10.1093/trstmh/try044, PMID 29788138
Davis CP. Normal flora. In: Medical Microbiology. Edinburgh: Elsevier; 1996.
WHO. Multidrug and Extensively Drug-Resistant Tuberculosis: 2010 Global Report on Surveillance and Response. Geneva, Switzerland: World Health Organization; 2010.
Qureshi A. A case of histoplasmosis mimicking tuberculosis. J Pak Med Assoc 2008;58:457-8. PMID 18822647
Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, et al. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med 2011;183:96-128. doi: 10.1164/rccm.2008- 740ST, PMID 21193785
Steingart KR, Henry M, Ng V, Hopewell PC, Ramsay A, Cunningham J, et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: A systematic review. Lancet Infect Dis 2006;6:570-81. doi: 10.1016/S1473-3099(06)70578-3, PMID 16931408
Laserson KF, Yen NT, Thornton CG, Mai VT, Jones W, An DQ, et al. Improved sensitivity of sputum smear microscopy after processing specimens with C18-carboxypropylbetaine to detect acid-fast bacilli: A study of United States-bound immigrants from Vietnam. J Clin Microbiol 2005;43:3460-2. doi: 10.1128/JCM.43.7.3460-3462.2005, PMID 16000478
Ganoza CA, Ricaldi JN, Chauca J, Rojas G, Munayco C, Agapito J, et al. Novel hypertonic saline-sodium hydroxide (HS-SH) method for decontamination and concentration of sputum samples for Mycobacterium tuberculosis microscopy and culture. J Med Microbiol 2008;57:1094-8. doi: 10.1099/jmm.0.2008/001339-0, PMID 18719178
e Castro TA, Mendes M, Freitas S, Roxo PC. Diagnostic yield of sputum microbiological analysis in the diagnosis of pulmonary tuberculosis in a period of 10 years. Rev Port Pneumol (2006) 2015;21:185-91. doi: 10.1016/j.rppnen.2014.09.010
Tripathi PC, Gajbhiye SR, Agrawal GN. Clinical and antimicrobial profile of Acinetobacter spp.: An emerging nosocomial superbug. Adv Biomed Res 2014;3:13. doi: 10.4103/2277-9175.124642, PMID 24600597
Ongkhammy S, Amstutz V, Barennes H, Buisson Y. The bleach method improves the detection of pulmonary tuberculosis in Laos. Int J Tuberc Lung Dis 2009;13:1124-9. PMID 19723402
Mindolli PB, Salmani MP, Parandekar PK. Improved diagnosis of pulmonary tuberculosis using bleach microscopy method. J Clin Diagn Res 2013;7:1336-8. doi: 10.7860/JCDR/2013/6152.3189, PMID 23998060
Ängeby KA, Hoffner SE, Diwan VK. Should the ‘bleach microscopy method’ be recommended for improved case detection of tuberculosis? Int J Tuberc Lung Dis 2004;8:806-15. PMID 15260270
Matu SW, Juma E. Improved Ziehl-Neelsen microscopy: Bleach sputum smear negative specimens after centrifugation. J Life Sci 2013;7:607- 12.
Muhammad KU, Bello M, Manga BS, Isa MA. Comparison between bleach concentration method and conventional ziehl neelsen technique of determination of Mycobacterium tuberculosis in sokoto metropolis. Int J Res 2014;1:504-11.
Yassin MA, Cuevas LE, Gebrexabher H, Squire SB. Efficacy and safety of short-term bleach digestion of sputum in case-finding for pulmonary tuberculosis in Ethiopia. Int J Tuberc Lung Dis 2003;7:678- 83. PMID 12870690
Bonnet M, Ramsay A, Githui W, Gagnidze L, Varaine F, Guerin PJ. Bleach sedimentation: An opportunity to optimize smear microscopy for tuberculosis diagnosis in settings of high prevalence of HIV. Clin Infect Dis 2008;46:1710-6. doi: 10.1086/587891, PMID 18444789
Singhal R, Bhalla M, Chakraborty S, Singh N, Behera D, Myneedu VP. Phenol-ammonium sulfate microscopy method for diagnosis of pulmonary tuberculosis. Int J Mycobacteriol 2013;2:84-8. doi: 10.1016/j.ijmyco.2013.03.003, PMID 26785894
Radhakrishnan R, Kumar MM, Prabuseenivasan S, Anbarasu S, Nagarajan P, Devisangamithirai M, et al. Assessment of panel slides prepared by phenol ammonium sulphate and NALC methods for proficiency testing. Int J Tuberc Lung Dis 2012;16:394-7. doi: 10.5588/ ijtld.11.0357, PMID 22640453
Yehia MM, Abdulla Z. Opportunistic fungi in lower respiratory tract infection among immunocompromised and immunocompetent patients. Ann Coll Med Mosul 2012;38:59-67. doi: 10.33899/mmed.2012.50093
el-Ebiary M, Torres A, Fàbregas N, de la Bellacasa JP, González J, Ramirez J, et al. Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med 1997;156 2 Pt 1:583-90. doi: 10.1164/ajrccm.156.2.9612023, PMID 9279244
Jha BJ, Dey S, Tamang MD, Joshy ME, Shivananda PG, Brahmadatan KN. Characterization of Candida species isolated from cases of lower respiratory tract infection. Kathmandu Univ Med J (KUMJ) 2006;4:290-4. PMID 18603921
Kidd SE, Hagen F, Tscharke RL, Huynh M, Bartlett KH, Fyfe M, et al. A rare genotype of Cryptococcus gattii caused the cryptococcosis outbreak on Vancouver Island (British Columbia, Canada). Proc Natl Acad Sci U S A 2004;101:17258-63. doi: 10.1073/pnas.0402981101, PMID 15572442
Fasih N, Jabeen K, Fatima T, Ahmed R, Zubairi AB, Zafar A. Pulmonary cryptococcosis mimicking tuberculosis in an immunocompetent host. Asian Pac J Trop Dis 2015;5:S114-5. doi: 10.1016/S2222- 1808(15)60870-2
Wong ML, Back P, Candy G, Nelson G, Murray J. Cryptococcal pneumonia in African miners at autopsy. Int J Tuberc Lung Dis 2007;11:528-33. PMID 17439676
Thambidurai L, Prabhuradhan R, Singhvi P, Ilanchezhian S, Ramachandran R, Shankar H. Cryptococcal pneumonia: The great mimicker. BJR Case Rep 2017;3:20150358. doi: 10.1259/ bjrcr.20150358, PMID 30363287
Jarvis JN, Wainwright H, Harrison TS, Rebe K, Meintjes G. Pulmonary cryptococcosis misdiagnosed as smear-negative pulmonary tuberculosis with fatal consequences. Int J Infect Dis 2010;14 Suppl 3:e310-2. doi: 10.1016/j.ijid.2010.02.2255
Couto MA, Liu L, Lehrer RI, Ganz T. Inhibition of intracellular Histoplasma capsulatum replication by murine macrophages that produce human defensin. Infect Immun 1994;62:2375-8. doi: 10.1128/ iai.62.6.2375-2378.1994, PMID 8188361
George P, Nayak N, Anoop TM, Gopi N, Vikram HP, Sankar A. Pulmonary histoplasmosis mimicking carcinoma lung. Lung India 2015;32:663-5. doi: 10.4103/0970-2113.168133, PMID 26664188
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