Fungi Identified in Patients with Recurrent Lung Disorders

Clinical and radiological features of fungal respiratory infections are nonspecific and have overlap with other respiratory diseases. A definitive diagnosis requires laboratory identification of the causative agents, of which the most frequent ones are Candida species, Aspergillus species, and Pneumocystis jirovecii.
The aim of this study was to evaluate the rate of fungi identified from the respiratory tract system of patients suffering from recurrent lung disorders (lung cancer or mycobacterial infections) by culture and real-time PCR.
One hundred and ninety-two bronchoalveolar lavage and sputum samples from 96 patients with clinical and radiological signs and symptoms of lung diseases were collected and cultured. The identification of fungi was made by the macroscopic and microscopic examination of the isolates and yeasts were identified by the API 20 C AUX system. Pneumocystis jirovecii was detected by the microscopic examination of the samples through immunofluorescence staining and real-time PCR.
Fungi identification was successful in 49/96 (51%) patients. The Candida species growth was observed in the culture of 28/96 (29.2%). Aspergillus species were isolated from 7 patients (7.3%). The most frequent species identified were Candida albicans, C. glabrata, C. krusei, Aspergillus flavus, and A. fumigatus. Pneumocystis jirovecii immunofluorescence staining was positive in 23.9% of the patients with more than five cysts and 42.7% of the patients with less than five cysts. By real time-PCR, P. jirovecii was detected in 54.2% of the patients.
A high frequency of identified fungi may be present as documented infection or colonization of the airways in pulmonary diseases. The management of high risk and immunosuppressed patients requires special attention to fungi identified from them.