Title: Detection of Airway colonization and Invasive Fungal Infections in Cases presenting with Respiratory Diseases in a Tertiary Care Hospital
Authors: Dr Santwana Verma, Dr Divya Chauhan, Dr Anumeha Gupta, Dr Sunil Sharma, Dr R. S. Negi
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.26
Abstract
The respiratory tract is frequently colonized by fungi and bacteria. Candida and Aspergillus species are the common fungi implicated but frequency of different species varies according to geographical areas. Such colonization may progress to invasive fungal disease especially in the immunocompromised individuals
Aim: To determine fungal pathogens eithercolonizing the airway or causing invasive infection in patients presenting with respiratory symptomsThe respiratory tract is frequently colonized by fungi and bacteria. Candida and Aspergillus species are the common fungi implicated but frequency of different species varies according to geographical areas. Such colonization may progress to invasive fungal disease especially in the immunocompromised individuals
Material and Methods: The present study included the historical cohort of 273 cases whose respiratory samples of bronchoalveolar lavage, sputum, endotracheal secretions or pleural fluid, were received for fungal culture between January 2011 and April 2017. The seasonal distribution, demographic profile of age and gender and causative fungi were studied
Results: Out of 273 cases, 182 were males and 91 females with male to female ratio of 2:1. 60.2% patients were more than fifty years of age. Out of 273 cases, 161 (58.9%) showed growth of fungi. Candida was isolated in 93(57.76%) and Aspergillus in 34 (21.11%) cases. The species of Candida included Candida albicans (46.23%) followed by C. tropicalis (15.05%), C. parapsilosis (5.37%), C. kefyr and C. melibiosica (1.07% each) and other non-albicans Candida species accounting for 31.18%. Species of Aspergillus included Aspergillus niger (44.11%), Aspergillus fumigatus (33.52%), Aspergillus flavus (11.76%), Aspergillus nidulans (2.94%) and other species (17.64%). Other significant isolates were Penicillum (16), Alternaria (4), Cladosporium (3) and one isolate each of Curvularia lunata, Paeciliomyces lilacinus, Rhizopus arrhizus, Mucor, Geotrichum and Trichosporon species
Conclusion: Close monitoring of patients with fungal colonization of the respiratory tract may help in early detection of development of invasive fungal disease and institution of antifungal therapy at an early stage when it is most beneficial. Awareness of prevalent species is of epidemiological significance and helps guide antifungal therapy
Keywords: bronchoalveolar lavage, colonization, Candida, Aspergillus
References
- Chakrabarti, Mould infection in ICUs. SIHAM- 11th National Conference of Society of Indian Human and Animal Mycologists, 2016.
- J.Kwon-Chung and J.E. Bennett, Aspergillosis,. Lea and Febiger, Philadelphia, United States Of America: Medical Mycology, 1992.
- Zarrinfar, s. Kaboli, S. Dolatabadi, and R. Mohammadi, “Rapid detection of Candida species in bronchoalveolar lavage fluid from patients with pulmonary symptoms,” Brazilian Journal of Microbiology,vol. 47, pp. 172-176, 2016.
- S. Knox and L. Meinke, “Role of bronchoalveolar lavage diagnostics in fungal infections,” Clin Chest Med , vol. 30, pp.355-365, 2009.
- Biswas, S. Agarwal, G. Sindhwani and J. Rawat, “Fungal colonization in patients with chronic respiratory diseases from Himalayan region of India,” Annals of Clinical Microbiology and Antimicrobials, vol. 9, pp. 28-34, 2010.
- D. Pauw, T.J. Walsh, J. Donnelly, D.A. Stewns, J.E. Edwards, T. Calandra, et al, “ Revised definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/ Invasive,” Clin Infect Dis, vol. 46(12),pp.1813-1821, 2008.
- G.Montero, P. Olaechea, F.A.Lerma, L.A.Rocha, J. Blanquer, B. Galvan, A. Rodriguez, et al, “Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient,” Rev Esp Quimioter, vol.26(2), pp. 173-188, 2013.
- K.Person, “Aspergillus niger: an unusual cause of invasive pulmonary aspergillosis,” J Med Microbiol, vol. 59, pp. 834-838, 2010.
- Fianchi, M. Picardi, L. Cudillo, L. Corvatta, L. Mele, G. Trape, C. Girmenia, L. Pagano., “Aspergillus niger infection in patients with haematological diseases: a report of eight cases.,” Mycoses, vol. 47, pp. 163-167, 2004.