The Egyptian Journal of Bronchology (Nov 2016)

Role of comorbidities in acquiring pulmonary fungal infection in chronic obstructive pulmonary disease patients

  • Ashraf Z. Mohamed,
  • Ahmad M. Moharrm,
  • Maha K. Ghanem,
  • Hoda A. Makhlouf,
  • Ebtesam M. El-Gezawy,
  • Sahar F. Youssif

DOI
https://doi.org/10.4103/1687-8426.193629
Journal volume & issue
Vol. 10, no. 3
pp. 243 – 250

Abstract

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Abstract Background Bacteria and viruses have been implicated as a major cause of chronic obstructive pulmonary disease (COPD) exacerbations; however, the potential role of fungal colonization and infection is poorly understood. Objective The aim of this study was to assess the profile of pulmonary fungal infection among COPD patients with and without comorbidities to determine their prevalence, risk factors, and outcome among those patients. Patients and methods In this prospective cross-sectional analytic study, different samples (sputum, bronchoalveolar lavage, blood, and others) from 177 COPD patients at risk for pulmonary fungal infection were examined using mycological analysis (direct microscopy and culture). Bronchoalveolar lavage and blood samples were examined using the human 1,3-β-D-glucan and galactomannan ELISA tests. Results The prevalence of pulmonary fungal infection was significantly higher in COPD patients with comorbidities (77.8%) versus COPD patients without comorbidities (53.1%) (P <0.001), with a predominance of Candida and Aspergillus spp. in both groups. Mechanical ventilation, corticosteroid therapy, ICU admission, and age were major risk factors for pulmonary fungal infection in COPD patients with comorbidities [P=0.012, odds ratio (ODR)=2.23; P=0.028, ODR=1.99; P=0.025, ODR=1.94; and P=0.034, ODR= 2.60; respectively]. COPD patients with comorbidities had significantly higher mortality rate (12.3%) compared with COPD patients without comorbidities (3.1%; P <0.05). Blood galactomannan antigen was positive in 16 (19.7%) COPD patients with comorbidities versus seven (7.3%) in COPD patients without comorbidities (P <0.05). Conclusion COPD patients with comorbidities had a higher prevalence of pulmonary fungal infection and higher mortality rate compared with COPD patients without comorbidities. Age, mechanical ventilation, corticosteroid therapy, and ICU admission were independent risk factors for pulmonary fungal infection in COPD patients with comorbidities.

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