肯尼亚肺结核患者中慢性肺部曲霉病的血清学证据。
Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya.
机构信息
Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya.
Kenya Medical Research Institute, Centre for Respiratory Diseases Research, Tuberculosis Laboratory, P.O.Box 54840-00200, Nairobi, Kenya.
出版信息
BMC Infect Dis. 2022 Oct 25;22(1):798. doi: 10.1186/s12879-022-07782-9.
BACKGROUND
Pulmonary tuberculosis (PTB) is a significant risk factor for fungal infection. The cavitary lesions post PTB serves as a good reservoir for fungal colonization and subsequent infection. Furthermore, the severe immunosuppression associated with HIV and TB co-infection is another predisposition. The inadequate capacity to investigate and manage fungal infection in PTB patients increases their morbidity and mortality. The study aimed to provide serological evidence of chronic pulmonary aspergillosis (CPA) among PTB patients in Kenya. Towards this, we analysed 234 serum samples from patients presenting with persistent clinical features of PTB infections despite TB treatment in four referral hospitals.
METHODS
This was a cross sectional laboratory based study and patients were recruited following an informed consent. Serological detection of Aspergillus fumigatus IgG was done using enzyme-linked immunosorbent assay (Bordier Affinity Products SA). Sputum samples were subjected to microscopy and standard fungal culture. The isolated fungi were subjected to macro and micro morphological identifications and confirmed by sequence analysis of calmadulin, betatubilin and ITS genes.
RESULTS
Serological evidence of CPA or fungal sensitization was 46(19.7%) and equivocal or borderline was 14(6.0%). Mycological investigations of sputum resulted in 88(38%) positive for fungal culture. Aspergillus spp. accounted for 25(28%) of which A. fumigatus was 13(14.8%), A. niger 8(9.1%), A. terreus, A. flavus, A. candidus and A. clavatus 1 (1.1%) each. This was followed by Penicillium spp. 10 (11.4%), Scedosporium spp. 5 (5.7%) and Rhizopus spp. 3 (3.4%). Among the yeasts; Candida albicans accounted for 18(20.5%) followed by C. glabrata 5(5.7%). Cryptococcus spp. was isolated from 3(3.4%) of the samples while 13(14.8%) were other yeasts.
CONCLUSION
Chronic pulmonary aspergillosis is a significant co-morbidity in PTB patients in Kenya that could be misdiagnosed as relapse or treatment failures in the absence of reliable diagnostic and clinical management algorithm. It could be the cause of persistent clinical symptoms despite TB treatment often misdiagnosed as TB smear/GeneXpert MTB/RIF® negative or relapse. We recommend that all patients with persistent clinical symptoms despite TB treatment should be subjected to fungal investigations before retreatment.
背景
肺结核（PTB）是真菌感染的重要危险因素。PTB 后的空洞病变为真菌定植和随后的感染提供了良好的储库。此外，HIV 和 TB 合并感染相关的严重免疫抑制是另一个易患因素。PTB 患者真菌感染的调查和管理能力不足，增加了他们的发病率和死亡率。本研究旨在为肯尼亚的 PTB 患者提供慢性肺曲霉病（CPA）的血清学证据。为此，我们分析了四家转诊医院中 234 例持续存在 PTB 感染临床特征的患者的血清样本。
方法
这是一项横断面实验室研究，在获得知情同意后招募患者。使用酶联免疫吸附试验（Bordier Affinity Products SA）检测烟曲霉 IgG 血清学。对痰液样本进行显微镜检查和标准真菌培养。分离的真菌进行宏观和微观形态学鉴定，并通过 calmadulin、betatubilin 和 ITS 基因序列分析进行确认。
结果
CPA 或真菌致敏的血清学证据为 46 例（19.7%），不确定或边界为 14 例（6.0%）。痰液的真菌学调查结果为 88 例（38%）真菌培养阳性。曲霉属占 25 例（28%），其中烟曲霉 13 例（14.8%），黑曲霉 8 例（9.1%），土曲霉、黄曲霉、棘孢曲霉和棒曲霉各 1 例（1.1%）。其次是青霉属 10 例（11.4%）、枝孢霉属 5 例（5.7%）和根霉属 3 例（3.4%）。在酵母中，白色念珠菌占 18 例（20.5%），近平滑念珠菌 5 例（5.7%）。从 3 例（3.4%）样本中分离出隐球菌属，13 例（14.8%）为其他酵母。
结论
慢性肺曲霉病是肯尼亚 PTB 患者的一种重要合并症，如果没有可靠的诊断和临床管理算法，可能会误诊为复发或治疗失败。它可能是导致 TB 治疗后持续临床症状的原因，通常被误诊为 TB 涂片/基因 Xpert MTB/RIF®阴性或复发。我们建议所有持续存在 TB 治疗后临床症状的患者在重新治疗前应进行真菌检查。
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