Fungal colonization in patients with chronic respiratory diseases from Himalayan region of India.
BACKGROUND
We screened patients with chronic respiratory diseases for microbiological and serological evidences of fungal colonisation; in order to determine its prevalence in this group of patients, examine potential clinical and radiological predictors of fungal colonisation and characterise fungal agents associated with individual diseases.


METHODS
BAL samples from 60 consecutive patients were subjected to microscopy and culture for fungal agents. Serum samples were analysed for precipitin antibodies to Aspergillus antigen and Candida cytoplasmic antigen. Statistical significance in the difference of fungal recovery between patient groups was determined using the Chi-square test.


RESULTS
The major diagnostic groups included patients with bronchogenic carcinoma (n = 31) and tubercular sequelae (n = 16). In all, 28 patients (46.7%) were culture-positive, with Candida and Aspergillus being recovered from 14 and 13 patients respectively. Twenty-one patients (35%) showed presence of precipitin antibodies. Patients with bronchogenic carcinoma showed increased predilection for colonisation with Aspergillus, while Candida was recovered more commonly in tubercular sequelae (p = 0.02). There was no statistically significant association between culture-positivity and specific risk factors/radiological findings.


CONCLUSIONS
The point-prevalence of fungal colonization was almost 50%. The combination of fungal culture and serology helped improve diagnostic sensitivity. An interesting predilection was observed for Aspergillus and Candida, to preferentially infect patients with Bronchogenic carcinoma and Tubercular sequelae respectively. In absence of specific predictors, the possibility of fungal colonization needs to be explored actively in these patients.
Biswas
Debasis
D
Deptartment of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand 248140, India. dbiswas71@rediffmail.com
Agarwal
Sonal
S
Sindhwani
Girish
G
Rawat
Jagdish
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000908:Antibodies, Fungal / Q000032:analysis; D001230:Aspergillus / Q000254:growth & development* / Q000276:immunology / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002175:Candida / Q000254:growth & development* / Q000276:immunology / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007194:India; D008168:Lung / Q000382:microbiology*; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy; D008175:Lung Neoplasms / Q000150:complications / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D012140:Respiratory Tract Diseases / Q000150:complications* / Q000382:microbiology; D014376:Tuberculosis / Q000150:complications / Q000382:microbiology
D000908:Antibodies, Fungal