Aspergillus colonization in patients with chronic obstructive pulmonary disease
M Shahi1, S A Ayatollahi Mousavi1, M Nabili2
1Department of Medical Mycology and Parasitology, Faculty of Medicine, Tropical and Infectious Diseases Center, Kerman University of Medical Sciences, Kerman, Iran.
Background And Purpose:
Chronic obstructive pulmonary disease (COPD) has been recognized as a risk factor for invasive aspergillosis. Airway colonization by Aspergillus species is a common feature of chronic pulmonary diseases. Nowadays, the incidence of COPD has increased in critically ill patients. The aim of the present study was to isolate and identify Aspergillus colonies in the respiratory tract of COPD patients.
Materials And Methods:
This study was performed on 50 COPD patients, who were aged above 18 years, and were in intensive care units of three hospitals in Sari, Iran, for at least six days. All the samples obtained from sputum, bronchoalveolar lavage, and tracheal aspirates were cultured for fungi each week. According to the conventional techniques, Aspergillus isolates were initially based on growth and standard morphological characteristics. To confirm the identification of grown Aspergillus, the partial beta-tubulin gene was sequenced using specific primers.
Results:
A total of 50 patients, who met our inclusion criteria, were enrolled in the study during 2012-14. The results showed that 27 (54%) and 23 (46%) of the participants were male and female, respectively. The majority of the patients developed dyspnea followed by hemoptysis, chest pain, and high fever. Corticosteroids and broad-spectrum antibacterial agents were administered to 75% and 80% of the patients, respectively. Based on the conventional and molecular approaches, A. fumigatus (seven cases; 43.7%), A. flavus (five cases; 31.2%), A. niger (one case; 6.2%), A. terreus (one case; 6.2%), A. orezea (one case; 6.2%), and A. tubingensis (one case; 6.2%) were recovered.
Conclusion:
Recovery of Aspergillus species from the respiratory tract of COPD patients with pneumonia indicates two possibilities: either colonization or invasive aspergillosis.
Insights
This study identified Aspergillus species in the respiratory tracts of 50 intensive care unit patients with chronic obstructive pulmonary disease (COPD). Aspergillus fumigatus and Aspergillus flavus were the most common species found, highlighting potential risks for invasive aspergillosis in these patients.
Area of Science:
- Medical Mycology
- Pulmonology
- Infectious Diseases
Background:
- Chronic obstructive pulmonary disease (COPD) is an increasing concern in critically ill patients.
- Airway colonization by Aspergillus species is common in chronic pulmonary diseases.
- COPD is a recognized risk factor for invasive aspergillosis.
Purpose of the Study:
- To isolate and identify Aspergillus species colonizing the respiratory tract of COPD patients.
- To investigate the prevalence of Aspergillus in mechanically ventilated COPD patients.
Main Methods:
- Fifty adult COPD patients in intensive care units were studied.
- Respiratory samples (sputum, bronchoalveolar lavage, tracheal aspirates) were cultured weekly for fungi.
- Aspergillus isolates were identified using conventional morphology and confirmed by partial beta-tubulin gene sequencing.
Main Results:
- Aspergillus species were recovered from the respiratory tracts of COPD patients.
- The most frequently identified species were Aspergillus fumigatus (43.7%) and Aspergillus flavus (31.2%).
- Other identified species included A. niger, A. terreus, A. orezea, and A. tubingensis.
Conclusions:
- The presence of Aspergillus species in COPD patients' respiratory tracts suggests either colonization or invasive aspergillosis.
- Further investigation is needed to differentiate between colonization and invasive disease in this vulnerable patient group.
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