Clinico-mycological profile of suspected pulmonary aspergillosis cases

Abstract

Introduction: Aspergillus is one of the most ubiquitous airborne saprophytic fungi. Humans constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms. With increase in the number of immunocompromised patients, there has been a dramatic increase in severe and fatal invasive aspergillosis (IA). The present study was aimed to know the clinico-mycological profile of suspected pulmonary aspergillosis cases. Methods: The present study was a prospective study conducted over a period of 1 year in the department of microbiology in admitted cases with clinical suspicion of pulmonary aspergillosis. Samples such as sputum, bronchoalveolar lavage, endotracheal secretions, fine-needle aspiration or biopsy and blood (for serological analysis) were collected and processed as per standard protocol. Results: Over a period of 1 year, 89 cases were included in the study. Their mean age was 58.7 years. Majority were male (60.6%). The most common presentation was cough (89.9%), followed by chest pain (57.3%) and fever (56.2% most common chest X-ray finding was homogeneous haziness (40.4%). Fungal smear was positive in 55.1% and 61.8% showed fungal growth. Galactomannan (GM) and (1-3)-β-D glucan positivity were 56% and 83.3%, respectively. The mortality was observed in 21.4% of patients. Conclusions: The study demonstrated that GM assay and (1-3)-β-D glucan assay are useful diagnostic modalities with a high sensitivity and specificity for the detection of pulmonary aspergillosis in high-risk patients along with positive fungal culture. Thus, these tests are early markers for IA.