Clinical characteristics and predictive model of pulmonary tuberculosis patients with pulmonary fungal coinfection

Abstract

Background In clinical settings, pulmonary tuberculosis (PTB) patients were often found to have pulmonary fungal coinfection. This study aimed to assess the clinical characteristics of patients suffering from coinfection with TB and pulmonary fungal and construct a predictive model for evaluating the probability of pulmonary fungal coinfection in patients with pulmonary tuberculosis. Methods The present case–control study retrospectively collected information from 286 patients affected by PTB who received treatment from December 6,2016- December 6,2021 at Beijing Chest Hospital, Capital Medical University. As control subjects, patients with sex and address corresponding to those of the case subjects were included in the study in a ratio of 1:1. These 286 patients were randomly divided into the training and internal validation sets in a ratio of 3:1. Chi-square test and logistic regression analysis were performed for the training set, and a predictive model was developed using the selected predictors. Bootstrapping was performed for internal validation. Results Seven variables [illness course, pulmonary cavitation, broad-spectrum antibiotics use for at least 1 week, chemotherapy or immunosuppressants, surgery, bacterial pneumonia, and hypoproteinemia] were validated and used to develop a predictive model which showed good discrimination capability for both training set [area under the curve (AUC) = 0.860, 95% confidence interval (CI) = 0.811–0.909] and internal validation set (AUC = 0.884, 95% CI = 0.799–0.970). The calibration curves also showed that the probabilities predicted using the predictive model had satisfactory consistency with the actual probability for both training and internal validation sets. Conclusions We developed a predictive model that can predict the probability of pulmonary fungal coinfection in pulmonary tuberculosis patients. It showed potential clinical utility.

The seroprevalence of anti-Histoplasma capsulatum IgG antibody among pulmonary tuberculosis patients in seven referral tuberculosis hospitals in Indonesia

“…Pulmonary TB patients are at higher risk of fungal infection due to altered bronchial structure and favorable growth sites in damaged lungs, such as oxygen-rich cavities and necrotic tissues, resulting from current or past TB infection [ 19 , 42 , 43 ]. Furthermore, pulmonary TB patients may be immunocompromised due to malnutrition, prolonged use of antibiotics, diabetes, and other comorbidities [ 42 – 44 ].…”

“…Pulmonary TB patients are at higher risk of fungal infection due to altered bronchial structure and favorable growth sites in damaged lungs, such as oxygen-rich cavities and necrotic tissues, resulting from current or past TB infection [ 19 , 42 , 43 ]. Furthermore, pulmonary TB patients may be immunocompromised due to malnutrition, prolonged use of antibiotics, diabetes, and other comorbidities [ 42 – 44 ]. The epidemiology and clinical similarities between pulmonary TB and histoplasmosis, as well as challenges with diagnostic examination for both diseases, confuse clinicians in establishing accurate diagnoses of TB, histoplasmosis, or co-infections of the two.…”

“…capsulatum IgG antibody positive result. Previous studies have described the association between pulmonary cavitation and immunocompromised status with fungal co-infection in pulmonary TB patients [ 42 ]. Cavities resemble an ideal culture plate for fungal colonization [ 42 ].…”

“…Previous studies have described the association between pulmonary cavitation and immunocompromised status with fungal co-infection in pulmonary TB patients [ 42 ]. Cavities resemble an ideal culture plate for fungal colonization [ 42 ]. Patients with malignancies are exposed to long-term chemotherapy or immunosuppressant that decreases immunity, thus making the patients more susceptible to fungal co-infection [ 42 ].…”

Unveiling the Hungarian landscape of laboratory and clinical management capacities for invasive fungal infections: navigating the frontlines against fungal menaces

“… 9 , 10 Moreover, M. tuberculosis could be a major predisposing factor for IFI particularly in case of invasive aspergillosis. 11 , 12 Based on Hungarian data reported by the European Center for Disease Prevention and Control (ECDC), Candida spp. are among the most frequently identified pathogens in intensive care unit-(ICU) acquired pneumonia (5.9%) and in ICU-acquired bloodstream infection (3.4%), whereas the urine Candida positivity rate in ICU is 13.3%.…”