This study was conducted in a tertiary care hospital in Western India^[1] To determine the spectrum and prevalence of pathogens in lower respiratory tract co-infections, in Pulmonary TB cases, with special emphasis on the filamentous fungi.^[2] To find out the relative risk of acquiring these infections in patients having TB-HIV co infection as compared to the patients having pulmonary TB without HIV.

Methodology: Lower respiratory specimens from 167 cases of pulmonary TB, admitted with respiratory complications were subjected to bacterial and fungal microscopy, cultures and identification. Giemsa Staining was done for detection of Pneumocystis carinii cysts.

Results: [1] Fungal pathogens found in 14.37% cases, out of which, 9.6% were candida sp. and 4.2% were fungal moulds while, Pneumocystis carinii cysts detected in 0.6%. [2] The moulds isolated were Fusarium sp.-- 1.8%, Aspergillus fumigatus-- 1.2%, Mucor sp.-- 1(0.6%) and Trichosporon sp.—1 (0.6%). [3] Bacterial pathogens found in 57.48% cases (44.3% mono-bacterial, 13.2% multibacterial coinfection), most common ones being, Klebsiella sp., and Pseudomonas sp. [5] Bacterial and fungal coinfection found in 10.18% cases. [6] TB and HIV co infection found in 4.2% cases and the relative risk of acquiring a respiratory filamentous fungal infection in patients having PTB+HIV co infection found to be 2.1, as compared to those having PTB without HIV. Thus, knowledge of the pathogen spectrum and prevalence of respiratory co-infections with TB (in a particular region), is essential for maintaining a high index of suspicion for the same, and for better patient management.

Keywords: Tuberculosis, Oppurtunistic Fungi, Filamentous Fungi, Moulds, TB –HIV coinfection.

1. Yahaya H., Taura D. W., Aliyu I. A., Bala J. A., Yunusa I., Ahmad I. M., Ali B. “Spectrum of opportunistic mould infections in suspected pulmonary tuberculosis (TB) patients.” International Journal of Microbio-logy and Application 2015; 2(1): 6-11
2. Elizabeth Nyambura Mwaura, Vivian Matiru1 and Christine Bii. “Mycological Findings of Sputum Samples from Pulmonary Tuberculosis Patients Attending TB Clinic in Nairobi, Kenya.” Virology and Mycology 2013, 2:3
3. Sunita Bansod and Mahendra Rai. “Emerging of Mycotic Infection in Patients Infected with Mycobacterium tuberculosis.” World Journal of Medical Sciences 3 (2): 74-80, 2008
4. J Mowna, Dinesh Kaliyamoorthi. “Mycological spectrum in Sputum samples of Pulmonary Tuberculosis Attending TB Clinic.” International Journal of Multidisciplinary Research and Development 2015; 2(2): 487-490
5. TB/HIV, A Clinical Manual, WHO 2004
6. J K Dutta, T K Dutta, S C Parija, “Emerging and Re-emerging Infectious Diseases” (Jaypee Publishers)
7. “Global Tuberculosis Control 2014” www.who.int/tb/publications/global_report
8. Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, et al. (1992) Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 1: 414-421.
9. Samson RA, Houbraken JAMP, Kuijpers AFA, Frank JM, Frisvad JC. New ochratoxin A or sclerotium producing species in Aspergillus. Studies in Mycology 2004; 50:45-46.
10. Mandanas et al, International Journal of Microbiology and Application 2015; 2(1): 6-11 7
11. Ramachandra Kamath, Vikram Sharma, Sanjay Pattanshetty, Mohandas B. Hegde,¹ and Varalakshmi Chandrasekaran HIV-TB coinfection: Clinico-epidemi-ological determinants at an antiretroviral therapy center in Southern India Lung India. 2013 Oct-Dec; 30(4): 302–306.
12.  Fidel PL (2002) Immunity to Candida. Oral Dis 8: 69-75.
13. Luetkemeyer, A. “Tuberculosis and HIV”, HIVInSite, http://hivinsite.ucsf.edu/
14.  “Implementing the WHO Stop TB Strategy: a handbook for national tuberculosis control programmes” Geneva, World Health Organization, 2008, p67 www.who.int/tb/publications/2008/
15. Sterling, T. “HIV Infection-Related Tuberculosis: Clinical Manifestations and Treatment” Clinical Infectious Diseases, 2010, Volume 50, Supplement 3.
16.  “The Global Plan to Stop TB”, WHO, Geneva, 2011, 12.
17. Piggott, D. “Timing of Antiretroviral Therapy for HIV in the Setting of TB Treatment” Clin Dev Immunol., 2011, 103917 www.hindawi.com/journals/cdi/”
18.  “Discussion – Diagnosis of Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB_IRIS)”, HIV web Study, 2011 //depts.washington.edu/ghivaids/reslimited/case3/
19. “Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a public health approach 2010 revision”, WHO, Geneva, 2010, 45 www.who.int/hiv/topics/treatment/en/index.html
20. Joan Robinson, MD, Colonization and infection of the respiratory tract: What do we know? Paediatr Child Health. 2004 Jan; 9(1): 21–24. PMCID: PMC2719511

Anisa Pal

Consultant Microbiologist (MD) and Hospital Infection Control Officer

Jabalpur Hospital and Research Centre, Jaabalpur, Madhya Pradesh, India

Tel: 9662740857, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.