Distribution of fungal agents in the respiratory system of patients with underlying lung diseases; molecular identification and antifungal susceptibility profiles

Parviz  Hassanpour; Seyed Jamal  Hashemi; Sanam  Nami; Roshanak Daie  Ghazvini; Behrouz Naghili  Hokmabadi; Abbas Rahimi  Foroushani; Kazem  Ahmadikia; Zahra  Ramezanalipour; Saeid Firouzi  Abriz

doi:10.18502/ijm.v16i6.17258

Parviz Hassanpour Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Seyed Jamal Hashemi Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Sanam Nami Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
Roshanak Daie Ghazvini Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Behrouz Naghili Hokmabadi Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abbas Rahimi Foroushani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Kazem Ahmadikia Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Zahra Ramezanalipour Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Saeid Firouzi Abriz Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

DOI: https://doi.org/10.18502/ijm.v16i6.17258

Keywords: Lung infection; Underlying lung diseases; Antifungal; Fungal agents; Polymerase chain reaction; Iran

Abstract

Background and Objectives: Airway fungal infection is a severe clinical problem, especially in patients with compromised immune functions. Here, we examined the distribution and antifungal susceptibility profiles of fungal agents isolated from respiratory tract of symptomatic patients hospitalized in pulmonary units.

Materials and Methods: This descriptive cross-sectional study took place from 2023 to 2024, involving 360 patients. Bron- choalveolar lavage (BAL) or sputum specimens were collected and analyzed using mycological and molecular methods for this study. Antifungal susceptibility testing (AFST) was carried out using the broth micro dilution method.

Results: Of a total of 360 respiratory specimens, 114 (31.6%) were positive. The male-to-female ratio was 63:51 (1.3%). Candida albicans and Aspergillus flavus were the most common yeast and mold species. Chronic obstructive pulmonary disease (COPD) had the highest rate of colonization with fungal agents (47/114, 41%). The isolates associated with COPD in this study included Aspergillus species (4/12, 3.5%), Candida species (41/96, 36%), and other fungal species (2/6, 1.5%). Coughing (87%) was the predominant symptom, and malignancy (52%) was the predominant comorbidity factor. The result of AFST for antifungal agents showed that 9 (22.5%) Candida isolates were resistant, and the highest rate of resistance was related to voriconazole agent (5/9, 55.5%). Resistance to antifungal agents was not observed among Aspergillus isolates.

Conclusion: This study showed a significant relationship between the frequency of Aspergillus and Candida species in patients with underlying lung diseases. In addition, voriconazole was more effective than itraconazole, especially against Aspergillus flavus.