Abstract
Aim: Pulmonary mycosis is a critical health issue with increasing morbidity and mortality internationally, especially in developing nations. We aim to study patients with pulmonary mycosis presenting to respiratory and medicine department in a tertiary care centre from February 2012-2013.
Material and Method: This is a prospective study of patients with pulmonary mycosis in a tertiary care centre. 56 patients with confirmed fungal sub-culture have been included. Study was done with the objective of assessing the epidemiology, clinical profile, associated co-morbidities and culture isolate pattern of pulmonary mycosis.
Result: Mean age group of our patient was 52.36 ±14.55 years. Pulmonary mycosis occurred in the setting of pre-existing lung disease in 64.28% of patients. Mycosis in naïve lung and with no immunocompromised condition was seen in 17.86% while 73.21% patients had an underlying lung disease or an immunocompr-omised status. Of the total patients, 23.21 % were diabetics, 5.35% had been having hematological malignancies, and 10.71% with autoimmune connective tissue disorders on steroids and 1.78% with retroviral disease. Our records suggest fungal culture isolates with prevalence of candida albicans (69.6%), candida krusei (12.5%), candida glaberata (10.7%), candida tropicalis (5%) and aspergillus fumigatus (5%).
Conclusion: Pulmonary mycosis is a challenging hassle in developing countries. Though, it is found usually in patients with underlying structural lung disease and immune-compromised hosts, a high index of clinical suspicion should be kept even in people with no obvious risk factors as primary pulmonary mycosis incidence in naïve lung is on rise. Our study also emphasizes the role of early bronchoscopy and lavage cultures for early diagnosis and more precise treatment for pulmonary mycosis.
Keywords: Pulmonary mycosis; diagnosis; culture isolate; risk factors.
References
- Van N Woerden, Hugo Cornelis et al. "Differences in fungi present in induced sputum samples from asthma patients and non-atopic controls: a community based case control study."BMC infectious diseases 1 (2013): 69.
- Panda, B. N. "Fungal infections of lungs: the emerging scenario."Indian Journal of Tuberculosis 2 (2004): 63-70.
- Luo, Bai-ling, et al. "Clinical analysis of 68 patients with pulmonary mycosis in China." Multidisciplinary respiratory medicine 5 (2011): 278.
- Shafiq Anwer, P. M., and Hayat Awan.et al “Radiological Manifestation of Pulmonary Mycosis."Pakistan J. Med. Res 1 (2003).
- Enoch, D. A., H. A. Ludlam, and N. M. Brown. "Invasive fungal infections: a review of epidemiology and management options." Journal of medical microbiology 7 (2006): 809-818.
- Peter, Elvis, et al. "Invasive pulmonary filamentous fungal infection in a patient receiving inhaled corticosteroid therapy. "Clinical Infectious Diseases 5 (2002): e54-e56.
- Rix E, Bickel RH, Baldauf G. Pulmonary Candia in immuno-compromised patients. Radiology 1997; 27(1); 25-8.
- Taviani M. LoCasto R.M, Verna A, Brigli G, Cariati E. The surgical treatment of pulmonary mucor mycosis. Minerva-Chir 1993; 30; 48(8): 435-7.
- Shimuzu Y, Watanaba Y, Oda M, Watanaba S, Hayashi Y, Iwa T, et al. A case of lung cancer suspected to be pulmonary mycosis of the fungus ball type. Nippon – Kyobu – Shikkan – Gakkai – Zaashi 1993; 28(9): 1252 – 6.
- Tedder M, Spartz J, Anstadt MP, Hegde SS, Tedder SD, Lowe JE. Pulmonary mucor mycosis. Ann ThorocSurg 1994; 57(4): 1044 – 50.)
- Bansod, Sunita, and MahendraRai. "Emerging of mycotic infection in patients infected with mycobacterium tuberculosis."World J Med Sci 3 (2008): 74-80.
- Jones, Brenda E., et al. "Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. "American Journal of Respiratory and Critical Care Medicine5 (1993): 1292-1297.
- Worthington, Michael. "Fatal Candida pneumonia in a non-immunosuppressed host." Journal of Infection 2 (1983): 159-161.
- Biswas, Debasis, et al. "Fungal colonization in patients with chronic respiratory diseases from Himalayan region of India."Annals of clinical microbiology and antimicrobials 1 (2010): 28.
- Mustafa El Ebiary, Antoni Torres, Neusfabregas et al "Significance of the Isolation ofCandida Species from Respiratory Samples in Critically Ill, Non-neutropenic Patients", American Journal of Respiratory and Critical Care Medicine, Vol.156, No. 2 (1997), pp. 583-590.
- Richardson, M., and C. Lass‐Flörl. "Changing epidemiology of systemic fungal infections."Clinical Microbiology and Infection 14s4 (2008): 5-24.
- St-Germain G, Laverdiere M, Pelletier R et al. Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: Results of a 2- year (1996-1998) multicentre surveillance study in Quebec, Canada. Journal of Clinical Microbiology. 2001; 39: 949-953
- Phukan AC, Sarmabardoloi JN, Mahanta J. Bronchopulmonary candidiasis in a tertiary referral hospital of Assam India.Ind J Med Sci. 2000; 54:491–494
- Bolton-JW, Lazaz-HL. Internal closure of aspergilloma cavity. South Med J 1993; 86(11): 1286 – 91.
- Gefter WB. The spectrum of pulmonary aspergillosis. J-Thorac-Imaging 1992; 1 7 (4): 56-74
- Gross B.H; Spitz H.B; Falson B. The mural nodule in cavitary opportunistic pulmonary aspergillosis. Radiology 1992; 143(3); 619 – 22
- Castagnone D, Radaelli P, Cortelezzi A. Radiological aspects of invasive pulmonary aspergillosis. Radial Med-(Jornia) 1984; 70 (1-2) 1-6.
- Saito, H., et al. "Bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in patients with acute leukemia."CHEST Journal 4 (1988): 745-749.
- Ray, Debidas, et al. "Raised serum IgE levels in chronic inflammatory lung diseases."The Ceylon medical journal 1 (1995): 14.establishing a network of diagnostic mycology laboratories.
- Marina, Neyssa M., et al. "Candida tropicalis and Candida albicansfungemia in children with leukemia." Cancer 68.3 (1991): 594-599.
Corresponding Author
Dr Vishak Acharya. K
Kasturba Medical College Mangalore, Manipal University
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.