Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya
Abstract Background Pulmonary tuberculosis (PTB) is a significant risk factor for fungal infection. The cavitary lesions post PTB serves as a good reservoir for fungal colonization and subsequent infection. Furthermore, the severe immunosuppression associated with HIV and TB co-infection is another...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-022-07782-9 |
| _version_ | 1811257195901222912 |
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| author | Abdi Mohamed Benear A. Obanda Hannah K. Njeri Sally N. Loroyokie Olga M. Mashedi Tom T. Ouko Evangeline M. Gatumwa Richard K. Korir Takashi Yaguchi Christine C. Bii |
| author_facet | Abdi Mohamed Benear A. Obanda Hannah K. Njeri Sally N. Loroyokie Olga M. Mashedi Tom T. Ouko Evangeline M. Gatumwa Richard K. Korir Takashi Yaguchi Christine C. Bii |
| author_sort | Abdi Mohamed |
| collection | DOAJ |
| description | Abstract Background Pulmonary tuberculosis (PTB) is a significant risk factor for fungal infection. The cavitary lesions post PTB serves as a good reservoir for fungal colonization and subsequent infection. Furthermore, the severe immunosuppression associated with HIV and TB co-infection is another predisposition. The inadequate capacity to investigate and manage fungal infection in PTB patients increases their morbidity and mortality. The study aimed to provide serological evidence of chronic pulmonary aspergillosis (CPA) among PTB patients in Kenya. Towards this, we analysed 234 serum samples from patients presenting with persistent clinical features of PTB infections despite TB treatment in four referral hospitals. Methods This was a cross sectional laboratory based study and patients were recruited following an informed consent. Serological detection of Aspergillus fumigatus IgG was done using enzyme-linked immunosorbent assay (Bordier Affinity Products SA). Sputum samples were subjected to microscopy and standard fungal culture. The isolated fungi were subjected to macro and micro morphological identifications and confirmed by sequence analysis of calmadulin, betatubilin and ITS genes. Results Serological evidence of CPA or fungal sensitization was 46(19.7%) and equivocal or borderline was 14(6.0%). Mycological investigations of sputum resulted in 88(38%) positive for fungal culture. Aspergillus spp. accounted for 25(28%) of which A. fumigatus was 13(14.8%), A. niger 8(9.1%), A. terreus, A. flavus, A. candidus and A. clavatus 1 (1.1%) each. This was followed by Penicillium spp. 10 (11.4%), Scedosporium spp. 5 (5.7%) and Rhizopus spp. 3 (3.4%). Among the yeasts; Candida albicans accounted for 18(20.5%) followed by C. glabrata 5(5.7%). Cryptococcus spp. was isolated from 3(3.4%) of the samples while 13(14.8%) were other yeasts. Conclusion Chronic pulmonary aspergillosis is a significant co-morbidity in PTB patients in Kenya that could be misdiagnosed as relapse or treatment failures in the absence of reliable diagnostic and clinical management algorithm. It could be the cause of persistent clinical symptoms despite TB treatment often misdiagnosed as TB smear/GeneXpert MTB/RIF® negative or relapse. We recommend that all patients with persistent clinical symptoms despite TB treatment should be subjected to fungal investigations before retreatment. |
| first_indexed | 2024-04-12T17:52:34Z |
| format | Article |
| id | doaj.art-56e5907550bd4fc386ca366eb90ca558 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-12T17:52:34Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-56e5907550bd4fc386ca366eb90ca5582022-12-22T03:22:27ZengBMCBMC Infectious Diseases1471-23342022-10-012211810.1186/s12879-022-07782-9Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in KenyaAbdi Mohamed0Benear A. Obanda1Hannah K. Njeri2Sally N. Loroyokie3Olga M. Mashedi4Tom T. Ouko5Evangeline M. Gatumwa6Richard K. Korir7Takashi Yaguchi8Christine C. Bii9Kenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections LaboratoryKenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections LaboratoryKenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections LaboratoryKenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections LaboratoryKenya Medical Research Institute, Centre for Respiratory Diseases Research, Tuberculosis LaboratoryKenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections LaboratoryKenya Medical Research Institute, Centre for Respiratory Diseases Research, Tuberculosis LaboratoryKenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections LaboratoryMedical Mycology Research Centre (MMRC), Division of BioResources, Chiba UniversityKenya Medical Research Institute, Centre for Microbiology Research, Mycology and Opportunistic Infections LaboratoryAbstract Background Pulmonary tuberculosis (PTB) is a significant risk factor for fungal infection. The cavitary lesions post PTB serves as a good reservoir for fungal colonization and subsequent infection. Furthermore, the severe immunosuppression associated with HIV and TB co-infection is another predisposition. The inadequate capacity to investigate and manage fungal infection in PTB patients increases their morbidity and mortality. The study aimed to provide serological evidence of chronic pulmonary aspergillosis (CPA) among PTB patients in Kenya. Towards this, we analysed 234 serum samples from patients presenting with persistent clinical features of PTB infections despite TB treatment in four referral hospitals. Methods This was a cross sectional laboratory based study and patients were recruited following an informed consent. Serological detection of Aspergillus fumigatus IgG was done using enzyme-linked immunosorbent assay (Bordier Affinity Products SA). Sputum samples were subjected to microscopy and standard fungal culture. The isolated fungi were subjected to macro and micro morphological identifications and confirmed by sequence analysis of calmadulin, betatubilin and ITS genes. Results Serological evidence of CPA or fungal sensitization was 46(19.7%) and equivocal or borderline was 14(6.0%). Mycological investigations of sputum resulted in 88(38%) positive for fungal culture. Aspergillus spp. accounted for 25(28%) of which A. fumigatus was 13(14.8%), A. niger 8(9.1%), A. terreus, A. flavus, A. candidus and A. clavatus 1 (1.1%) each. This was followed by Penicillium spp. 10 (11.4%), Scedosporium spp. 5 (5.7%) and Rhizopus spp. 3 (3.4%). Among the yeasts; Candida albicans accounted for 18(20.5%) followed by C. glabrata 5(5.7%). Cryptococcus spp. was isolated from 3(3.4%) of the samples while 13(14.8%) were other yeasts. Conclusion Chronic pulmonary aspergillosis is a significant co-morbidity in PTB patients in Kenya that could be misdiagnosed as relapse or treatment failures in the absence of reliable diagnostic and clinical management algorithm. It could be the cause of persistent clinical symptoms despite TB treatment often misdiagnosed as TB smear/GeneXpert MTB/RIF® negative or relapse. We recommend that all patients with persistent clinical symptoms despite TB treatment should be subjected to fungal investigations before retreatment.https://doi.org/10.1186/s12879-022-07782-9Chronic pulmonary aspergillosisPulmonary tuberculosisResource limited settingsAspergillus serologySeroprevalenceKenya |
| spellingShingle | Abdi Mohamed Benear A. Obanda Hannah K. Njeri Sally N. Loroyokie Olga M. Mashedi Tom T. Ouko Evangeline M. Gatumwa Richard K. Korir Takashi Yaguchi Christine C. Bii Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya BMC Infectious Diseases Chronic pulmonary aspergillosis Pulmonary tuberculosis Resource limited settings Aspergillus serology Seroprevalence Kenya |
| title | Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya |
| title_full | Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya |
| title_fullStr | Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya |
| title_full_unstemmed | Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya |
| title_short | Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya |
| title_sort | serological evidence of chronic pulmonary aspergillosis in tuberculosis patients in kenya |
| topic | Chronic pulmonary aspergillosis Pulmonary tuberculosis Resource limited settings Aspergillus serology Seroprevalence Kenya |
| url | https://doi.org/10.1186/s12879-022-07782-9 |
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