Department of Biological Sciences, Division of Medical Microbiology, Abubakar Tafawa Balewa University, Bauchi, Nigeria.
Department of Microbiology, Bauchi State University, Gadau, Nigeria.
Int J Mycobacteriol. 2020 Apr-Jun;9(2):144-149. doi: 10.4103/ijmy.ijmy_46_20.
Pulmonary mycosis (PM) poses a great diagnostic challenge due to the lack of pathognomonic and radiological features, especially in the absence of mycology laboratory tests. This study was aimed to isolate, phenotypically identify, determine the prevalence of pulmonary fungal pathogens and antifungal susceptibility pattern of isolates of presumptive tuberculosis (PTB) patients attending Federal Teaching Hospital (FTH) Gombe, Nigeria.
After ethical approval, three consecutive early morning sputa were collected from 216 participants with presumptive of PTB attending FTH Gombe, between May 2, 2017 and May 30, 2018. Samples were processed using standard mycological staining, microscopy, sugar biochemistry, and antifungal susceptibility test protocols. Sociodemographic variables and risk factors of pulmonary fungal infection were assessed through structured questionnaires. Pulmonary fungal infection was defined by the positive culture in at least two sputa. PTB was defined by Genexpert nested polymerase chain reaction.
Of the 216 participants, 19.9% had PTB and 73.6% had pulmonary fungal pathogens. Among the isolated pulmonary fungal pathogens, Aspergillus fumigatus made the highest occurrence, while 6.5% had PTB-fungal co-infection. No significant association existed between the prevalence of PM with age and sex of participants (P < 0.05). Cigarette smoking (adjusted odds ratio [aOR] = 15.9 [95% confidence interval (CI): 0.9-268.8]), prolong antibiotic use (aOR = 77.9 [95% CI: 4.7-1283]) and possession of domestic pet (aOR = 77.9 [95% CI: 4.7-1283]) were significant risk factors of PM (P < 0.05). Penicillium citrinum, Mucor spp. and Aspergillus flavus are more susceptible to voriconazole, and Candida albicans was found to be more susceptible to Nystatin. Of the 159 fungal isolates, 92.5% were resistant to fluconazole.
Findings from this study revealed high level pulmonary fungal pathogens, especially among PTB patients. A majority of fungal isolates were resistant to fluconazole. It's recommended that persons should do away with or minimize risk factors for pulmonary fungal pathogens identified in this study.
由于缺乏特征性和影像学特征，尤其是在没有真菌学实验室检查的情况下，肺部真菌感染（PM）的诊断极具挑战性。本研究旨在分离、表型鉴定、确定在尼日利亚贡贝联邦教学医院（FTH）就诊的疑似肺结核（PTB）患者的肺部真菌病原体的流行率和分离株的抗真菌药敏模式。
在获得伦理批准后，于 2017 年 5 月 2 日至 2018 年 5 月 30 日期间，连续采集 216 名疑似肺结核患者的 3 份清晨痰液样本。使用标准的真菌学染色、显微镜检查、糖生物化学和抗真菌药敏试验方案处理样本。通过结构化问卷评估肺部真菌感染的社会人口学变量和危险因素。通过至少两份痰液的阳性培养来定义肺部真菌感染。PTB 通过 Genexpert 巢式聚合酶链反应来定义。
216 名参与者中，19.9%患有肺结核，73.6%患有肺部真菌病原体。在分离出的肺部真菌病原体中，烟曲霉的发生率最高，而 6.5%的患者存在肺结核-真菌合并感染。PM 的患病率与参与者的年龄和性别无显著相关性（P<0.05）。吸烟（调整优势比[aOR] = 15.9[95%置信区间（CI）：0.9-268.8]）、延长使用抗生素（aOR = 77.9[95%CI：4.7-1283]）和拥有宠物（aOR = 77.9[95%CI：4.7-1283]）是 PM 的显著危险因素（P<0.05）。青霉菌、毛霉菌和黄曲霉对伏立康唑更敏感，而白色念珠菌对制霉菌素更敏感。在 159 株真菌分离株中，92.5%对氟康唑耐药。
本研究结果显示，肺部真菌病原体水平较高，尤其是在肺结核患者中。大多数真菌分离株对氟康唑耐药。建议人们应避免或尽量减少本研究中确定的肺部真菌病原体的危险因素。
