Characteristics and risk factors of pulmonary fungal infection in patients with pulmonary tuberculosis.

Abstract

Objective: To investigate the characteristics of and the risk factors for pulmonary fungal infection in patients with pulmonary tuberculosis (PT).

Methods: A retrospective analysis was conducted on the clinical data of 218 PT patients treated at Beijing Luhe Hospital Affiliated with Capital Medical University from May 2022 to May 2024. Based on the presence or absence of fungal infection, these 218 patients were assigned to an infection group (n=87) or a non-infection group (n=131). Clinical baseline data, pulmonary fungal infection status ten days after admission, clinical symptoms on the first day of admission, and serum protein and hemoglobin levels were compared between the two groups. Logistic regression analysis was conducted to identify independent risk factors for pulmonary fungal infection in PT patients. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive performance of these independent risk factors.

Results: Among the 218 PT patients included, 87 (39.91%) had fungal infections. A total of 210 fungal strains were isolated and cultured from the infection group, with Candida albicans accounting for the highest proportion (42.65%), followed by candida tropicalis (20.59%) and Candida glabrata (17.65%). The infection group exhibited significantly higher rates of cough, fever, anemia, and pulmonary rales compared to the non-infection group (all P<0.05). The infection group showed significantly lower levels of serum protein and hemoglobin than the non-infection group (P<0.0001). Multivariate analysis identified history of smoking, disease course, duration of corticosteroid use, invasive procedure, serum protein level, and hemoglobin level as independent factors for fungal infection in PT patients. ROC curve analysis indicated that serum protein levels had the highest accuracy and area under the curve (AUC) value, while smoking history and hemoglobin levels performed less well in the model.

Conclusion: This study found a high rate of pulmonary fungal infections among PT patients, with Candida albicans being the most prevalent, followed by candida tropicalis and Candida glabrata. A history of smoking, a prolonged disease course, invasive procedures, extended corticosteroid use, and low serum protein and hemoglobin levels are independent factors for fungal infection in PT patients.