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Mohamed A, Obanda BA, Njeri HK, Loroyokie SN, Mashedi OM, Ouko TT, Gatumwa EM, Korir RK, Yaguchi T, Bii CC. Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya. BMC Infect Dis 2022; 22:798. [PMID: 36284285 PMCID: PMC9594872 DOI: 10.1186/s12879-022-07782-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/17/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Abdi Mohamed
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Benear A. Obanda
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Hannah K. Njeri
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Sally N. Loroyokie
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Olga M. Mashedi
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Respiratory Diseases Research, Tuberculosis Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Tom T. Ouko
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Evangeline M. Gatumwa
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Respiratory Diseases Research, Tuberculosis Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Richard K. Korir
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
| | - Takashi Yaguchi
- grid.136304.30000 0004 0370 1101Medical Mycology Research Centre (MMRC), Division of BioResources, Chiba University, 1-8- 1 Inohana, Chuo-ku, 260-8673 Chiba, Japan
| | - Christine C. Bii
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections Laboratory, P.O.Box 54840-00200, Nairobi, Kenya
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Kim SB, Lee WY, Lee JH, Lee SJ, Lee MK, Kim SH, Uh Y, Jung SH, Shin B. A variety of bacterial aetiologies in the lower respiratory tract at patients with endobronchial tuberculosis. PLoS One 2020; 15:e0234558. [PMID: 32584852 PMCID: PMC7316277 DOI: 10.1371/journal.pone.0234558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022] Open
Abstract
Recently, our understanding of the elusive bacterial communities in the lower respiratory tract and their role in chronic lung disease has increased significantly. However, little is known about the respiratory microorganisms in patients with endobronchial tuberculosis (EBTB), which is a chronic inflammatory disease characterized by destruction of the tracheobronchial tree due to Mycobacterium tuberculosis (MTB) infection. We retrospectively reviewed data for histopathologically and microbiologically confirmed EBTB patients diagnosed at a tertiary referral hospital in South Korea between January 2013 and January 2019. Bacterial cultures were performed on bronchial washing from these patients at the time of EBTB diagnosis. A total of 216 patients with EBTB were included in the study. The median age was 73 years and 142 (65.7%) patients were female. Bacteria were detected in 42 (19.4%) patients. Additionally, bacterial co-infection was present in 6 (2.8%) patients. Apart from MTB, the most common microorganisms identified were Staphylococcus aureus (n = 14, 33.3%) followed by Klebsiella species (n = 12, 28.6%; 10 Klebsiella pneumoniae, 2 Klebsiella oxytoca), Streptococcus species (n = 5, 11.9%), Enterobacter species (n = 4, 9.5%), and Pseudomonas aeruginosa (n = 3, 7.1%). A variety of microorganisms were isolated from the bronchial washing indicating that changes in microorganism composition occur in the airways of patients with EBTB. Further studies are needed to investigate the clinical significance of this finding.
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Affiliation(s)
- Sae Byol Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Soon-Hee Jung
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Beomsu Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- * E-mail:
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Hedayati MT, Azimi Y, Droudinia A, Mousavi B, Khalilian A, Hedayati N, Denning DW. Prevalence of chronic pulmonary aspergillosis in patients with tuberculosis from Iran. Eur J Clin Microbiol Infect Dis 2015; 34:1759-65. [PMID: 26003310 DOI: 10.1007/s10096-015-2409-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
Abstract
In patients with preexisting lung disease, especially a cavity, Aspergillus can infect the surface of the cavity, causing chronic cavitary pulmonary aspergillosis (CCPA), and may form an aspergilloma, collectively called chronic pulmonary aspergillosis (CPA). In the present study, we assessed tuberculosis (TB) patients for CPA based on culture and serological methods. During a period of 1 year (from March 2013 to March 2014), we studied 124 patients with TB (94 with current TB and 30 with previous TB) at Masih Daneshvari Hospital in Tehran, Iran. Sputum specimens were analyzed by direct microscopic examination (DME) and fungal culture. The clinical and radiological features of all patients were recorded, to categorize the patients into CCPA and aspergilloma. All patients were screened for serum-specific IgG against A. fumigatus, by enzyme-linked immunosorbent assay (ELISA). Out of 124 patients with TB (66 male, age range: 10-91 years), 48 patients (38.7 %) exhibited residual cavities. Eighteen (14.5 %) patients had cavities with pleural thickening. A round-shaped mass lesion was detected in six patients (6.8 %). DME was positive in ten patients for septate fungal hyphae. A. fumigatus was grown from 14 samples. Fifty-five (44.3 %) cases were positive for serum-specific IgG against A. fumigatus. Of 124 patients with TB, 3 (2.4 %) met criteria for aspergilloma and 14 (11.3 %) for CCPA. CPA is a common clinical presentation in individuals with healed TB in Iran, as reported by previous studies from other countries.
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Affiliation(s)
- M T Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Km 18 Khazarabad Road, P.O. Box 48175-1665, Sari, Iran,
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Seki N, Shiozaki G, Ota M, Ota S, Seki R, Seto T, Uematsu K, Eguchi K. Risk Factors for a Second Episode of Hemoptysis. CLINICAL MEDICINE. CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2009. [DOI: 10.4137/ccrpm.s1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives Hemoptysis is an alarming symptom of underlying lung disease. Clinicians are often unsure how to deal with and follow up patients who have had a single episode of hemoptysis, especially if the cause remains unknown despite thorough examination, because a second, more severe episode of hemoptysis might occur despite an apparently stable condition. Investigations were done, using multivariate analyses, to see whether several clinical factors present during an initial episode of hemoptysis could be used to predict a second episode. Subjects and Methods Eighty patients with an initial episode of hemoptysis who underwent both computed tomographic and bronchoscopic examinations from 2003 through 2005 were reviewed. Results The isolation of bacteria from bronchial lavage fluid (odds ratio 13.5, P = 0.001) and the failure to determine the cause of the initial episode of hemoptysis (odds ratio 7.0, P = 0.014) were significant independent predictors of a second episode of hemoptysis. Subset analysis showed that isolation of either Pseudomonas aeruginosa or Haemophilus influenzae increased the likelihood of a second episode of hemoptysis (P = 0.077), even if colonization, representing host-bacterial equilibrium, had occurred. Furthermore, the failure to determine the etiology of an initial episode of hemoptysis was associated with an increased risk of a massive second episode (P = 0.042), regardless of the volume of the initial episode. Conclusions In patients with bacterial colonization of the respiratory tract or an initial episode of hemoptysis of unknown etiology, there is an increased possibility of a second episode of hemoptysis.
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Affiliation(s)
- Nobuhiko Seki
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Go Shiozaki
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Mayuko Ota
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Shuji Ota
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Reishi Seki
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Department of Laboratory Medicine, Isehara Kyodo Hospital, Isehara, Kanagawa, Japan
| | - Takashi Seto
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kazutsugu Uematsu
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Division of Pulmonary Medicine, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Kenji Eguchi
- Division of Medical Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
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