Epidemiology, laboratory diagnosis and clinical aspects offungal pulmonary infections in ۳۸۴ patients hospitalized in pulmonaryunits in Guilan province, Iran

Background and Aim : The respiratory tract is the most common site for developing fungalinfections. People who have a weakened immune system are more susceptible to respiratorysystem involvement with fungi. Fungal infections of the respiratory tract are largely unrecognizedand their true burden is elusive. Therefore, the aim of the current study was to evaluate the clinicalspectrum, demographic characteristics, risk factors, and etiology of fungal respiratory infectionsin ۳۸۴ patients hospitalized in pulmonary units of Razi hospital, Guilan province, Iran.Methods : A total of ۳۸۴ lung specimens (۱۹۲ Bronchoalveolar lavages (BAL) and ۱۹۲ sputa)were obtained from patients who met the inclusion criteria. All samples were analyzed by directmicroscopy and culture. Fungal identification was accomplished by internal transcribed spacer(ITS) and beta-tubulin sequencing. Also, in patients suspected to invasive pulmonary aspergillosisBAL specimens were tested for galactomannan (GM) antigen. According to the host factors(clinical symptoms, radiology findings and predisposing factors which were defined as inclusioncriteria), and the positive results in direct examination, culture and serology (GM for aspergillosis)the infection was confirmed.Results : Fungal respiratory infection was confirmed in ۱۳۷ cases (۳۵.۶۷%) including ۸۶ (۶۲.۷۷%)males and ۵۱ (۳۷.۲۳%) females and the highest prevalence of infection was found in the age groupof ۴۶-۷۲ years (n=۷۵, ۵۴.۷۴%). Cough (n=۱۲۹, ۹۴.۱۶%), dyspnea (n=۱۱۱, ۸۱.۰۲%), purulentsputum (n=۸۵, ۶۲.۰۴%) and weight loss (n=۷۷, ۵۶.۲%) were the predominant symptoms.Tuberculosis (n=۳۴, ۲۴.۸۱%), taking chemotherapy regimen (n=۳۰, ۲۱.۸۹%) and diabetes mellitus(n=۲۷, ۱۹.۷۰%) were the predominant underlying conditions. Candida albicans (۳۷.۲۲%) andCandida tropicalis (۲۱.۸۹%) represent the two most commonly isolated species in the currentstudy. Furthermore, according to revised EORTC/MSG (۲۰۰۸) definitions for invasive fungalinfections, from ۵ cases of pulmonary aspergillosis, ۲ (۴۰%) cases of probable invasive pulmonaryaspergillosis (IPA) and ۳ (۶۰%) cases of possible IPA were diagnosed.Conclusion : Many physicians missed fungal pulmonary infection because it does not showspecific clinical manifestations. Given that some of uncommon causal agents of fungal pulmonaryinfections are intrinsically resistant to routine antifungal drugs and could cause treatment failure,mycological examinations should be considered for proper treatment.

کلیدواژه ها:

Bronchoalveolar lavage ، Sputum ، Candidiasis ، Fungal respiratory infections ، Invasivepulmonary aspergillosis ، Galactomannan antigen