An Emerging Neglected Co-infection: Aspergillus fumigatus and Mycobacterium gordonae Co-infection in an Immunocompromised Patient

Abstract

Non Tuberculous Mycobacteria (NTM) commonly affect the immunocompromised patients afflicted with chronic pulmonary disease and other opportunistic infections such as Aspergillus species. Although the symptoms and signs are similar for both, early laboratory diagnosis and treatment would reduce the duration of hospitalisation and unnecessary exposure to antimicrobials. Since NTM and Aspergillus species co-infection is an emerging trend, and delay in diagnosis and treatment can cause major complications, it is essential to clinically suspect the same, and this will help in early diagnosis of the infection, keeping in mind the delayed growth of NTM and Aspergillus species in culture and the time taken to identify the infecting organism. Here, an interesting case of an immunocompromised 63-year-old male patient with Chronic Obstructive Pulmonary Disease (COPD) on frequent treatment who had symptoms of cough with expectoration, breathlessness on exertion, malaise, loss of weight and apetite for three months is reported. The patient was conscious, oriented and cachectic with complaints of breathing difficulty at the time of admission. Considering the positive report of sputum for Acid Fast Bacilli (AFB) and negative GeneXpert report, the patient sample was tested by Polymerase Chain Reaction (PCR) for NTM which was positive. The patient was diagnosed with Mycobacterium gordonae (M. gordonae) and Aspergillus fumigatus co-infection.

Keywords

• chronic obstructive pulmonary disease
• genexpert
• non tuberculous mycobacteria
• pulmonary aspergillosis