Co-infection of pulmonary tuberculosis with fungal pathogens in patients with lower respiratory tract infections referred to St. Peter's Specialized Hospital, Addis Ababa, Ethiopia. A prospective cross-sectional study

Abstract

Background

TB is still a problem worldwide despite efforts to eradicate it, and co-infection with fungal diseases presents a serious risk.

Objective

To ascertain the frequency and causes of TB fungal co-infection and tuberculosis in individuals with lower respiratory tract infection symptoms.

Materials and methods

A prospective hospital-based, cross-sectional study was conducted at the study site through November 2023 and May 2024. From 530 study participants, sputum samples were obtained. Using a GeneXpert equipment, a portion of the sputum was used for the diagnosis of tuberculosis. The remaining sample was grown, and the fungal isolates were identified using conventional microbiological techniques.

Results

530 sputum samples in all were gathered, and the samples were tested for lower respiratory tract infections. Males were slightly less than females and middle-aged to elderly study subjects were dominant. Forty-seven (7.9 %) samples were Gene Xpert positive and 189 (36.7 %) samples were fungal culture positive. Of 42 Gene Xpert-positive patients 23(4.3 %) were infected with TB only and 19(3.9 %) patients were TB co-infected with fungal pathogens. Cough was the most common sign and symptom accounting for 99.2 %. Among chest radiograph abnormalities 45(8.5 %%) patients had cavity lesions. Different chest radiograph classifications showed different distributions of the organisms found in sputum (p < 0.001). About 21 (4.0 %) study subjects were with diabetes where 12 were with fungal infection, 2 were TB co-infected with fungal pathogens.

Conclusion

Of the 42 Xpert-positive patients with respiratory infection symptoms who were tested for TB and fungal pathogens, 23 (4.3 %) had tuberculosis exclusively, and 19 (3.9 %) had co-infections of TB and fungal pathogens. Among fungal isolates, 183 (75.9 %) were yeasts while 58 (24.1 %) isolates were molds. Among fungal isolates, 183 (75.9 %) were yeasts while 58 (24.1 %) isolates were molds. Fungal pathogen screening should be done concurrently with tuberculosis screening.