Jabbari Amiri Mohammad Reza, Aghili Seyed Reza, Shokohi Tahereh, Hedayati Mohammad Taghi, Abastabar Mahdi, Aliyali Masoud, Jabbari Amiri Masoumeh, Hasanpour Hamid
Invasive Fungi Research Center, Department of Medical Mycology and Parasitology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Invasive Fungi Research Center, Department of Medical Mycology and Parasitology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Int J Mycobacteriol. 2016 Dec;5 Suppl 1:S179-S180. doi: 10.1016/j.ijmyco.2016.08.010. Epub 2016 Sep 20.
OBJECTIVE/BACKGROUND: Tuberculosis (TB) continues to be a major public health problem worldwide. This is especially true in Northern Iran, which has high TB prevalence. The chronic nature of this disease is further exacerbated if it is accompanied by fungal infection, which usually remains undiagnosed and thus untreated. Thus, mycotic infections add fatal dimensions to pulmonary TB. Our objective was to determine the prevalence of invasive forms of fungal elements in sputum samples collected from patients with pulmonary TB at a reference laboratory in Ghaemshahr, Northern Iran, during the past 10years.
In this retrospective study, sputum samples collected from 430 patients were examined. Pulmonary TB in patients was confirmed in our laboratory, and samples obtained during the period from March 2006 to February 2016 were analyzed. The sputum samples were subjected to biological (bacterial) staining (Ziehl-Neelsen and fluorochrome) and mycological investigation using KOH Calcofluor White (Sigma-Aldrich, India) by fluorescent microscopy and fungal culture on Sabouraud dextrose agar (Sigma-Aldrich, India) and CHROMagar (Paris, France).
Invasive forms of fungal pathogens were observed as co-infection with Mycobacterium tuberculosis in 28/430 cases (6.51%). The frequency of Aspergillus, both branching and dichotomous infection, accounted for 3.72% (16/430): Aspergillus flavus, 1.63%; Aspergillus fumigatus, 1.16%; Aspergillus niger, 0.69%; and Aspergillus oryzae, 0.23%, respectively. Blastoconidia and pseudohyphae forms of yeast were observed as co-infection with M. tuberculosis in 2.79% (12/430) of the cases: Candida albicans, 1.86%; Candida krusei, 0.46%; and other Candida species, 0.46%, respectively.
Northern Iran is a critical region in the TB world and multidrug-resistant TB is a serious problem in this region. Although it is believed that there exists a commensal relationship between fungus and TB infections, the invasive forms of fungal pathogens and their co-infection can be caused by increasing disability and failure of treatment. Diagnosis of secondary or co-existing fungal infections in TB is most important for reducing the mortality and morbidity of these patients.
目的/背景：结核病仍是全球主要的公共卫生问题。在结核病患病率较高的伊朗北部尤其如此。如果这种疾病伴有真菌感染，而真菌感染通常仍未得到诊断和治疗，那么其慢性性质会进一步恶化。因此，霉菌感染为肺结核增添了致命因素。我们的目的是确定过去10年期间在伊朗北部加姆沙赫尔一家参考实验室从肺结核患者采集的痰液样本中侵袭性真菌成分的患病率。
在这项回顾性研究中，对从430名患者采集的痰液样本进行了检查。患者的肺结核在我们实验室得到确诊，并对2006年3月至2016年2月期间获取的样本进行了分析。痰液样本进行了生物（细菌）染色（萋-尼氏染色和荧光染色），并使用KOH荧光增白剂（Sigma-Aldrich，印度）通过荧光显微镜进行真菌学检查，以及在沙氏葡萄糖琼脂（Sigma-Aldrich，印度）和科玛嘉显色培养基（法国巴黎）上进行真菌培养。
在28/430例（6.51%）病例中观察到真菌病原体的侵袭形式与结核分枝杆菌合并感染。曲霉，包括分支状和二分状感染，频率占3.72%（16/430）：黄曲霉，1.63%；烟曲霉，1.16%；黑曲霉，0.6%；米曲霉，0.23%。在2.79%（12/430）的病例中观察到酵母的芽生孢子和假菌丝形式与结核分枝杆菌合并感染：白色念珠菌，1.86%；克鲁斯念珠菌，0.46%；其他念珠菌属，0.46%分别。
伊朗北部是结核病领域的一个关键地区，耐多药结核病在该地区是一个严重问题。尽管人们认为真菌与结核病感染之间存在共生关系，但真菌病原体的侵袭形式及其合并感染可能导致残疾增加和治疗失败。诊断结核病中的继发性或并存真菌感染对于降低这些患者的死亡率和发病率最为重要。
