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PREVALENCE of FUNGAL PATHOGENS AMONG RESPIRATORY TRACT INFECTIONS Abbas M Al-Ammari et al (2019): Fungal Pathogens in RTIs November 2019 Vol. 22(8) PREVALENCE OF FUNGAL PATHOGENS AMONG RESPIRATORY TRACT INFECTIONS Abbas M. AL-Ammari1*, Anaam Fuad Hussain2, Thuraya Kadhim Ismael3 1. Biology Department, College of Science, Diyala University, Iraq. 2. Biotechnology Department, College of Science, Diyala University, Iraq. 3. Iraqi Ministry of Health and Environment, Diyala Health Environment, Baquba Teaching Hospital, Iraq Corresponding author E-mail: [email protected] ABSTRACT One-third of infections associated mortality is caused by respiratory diseases. Among these accounting, fungal respiratory infections are largely unrecognized. Although treatment, most invasive fungal infections stilled responsible forhigh mortality. Fungal spores typically enter the lung by inhalation, the spores reach lung through the bloodstream and cause fungal pneumonia. Inside the alveoli, the fungal spores travel throughout intracellular spaces and also passage to adjacent alveoli through connecting pores. One hundred twenty specimens including bronchoalveolar lavage, sinus, and sputum (40 specimens each) were randomized collected from patients with respiratory problems who attended Baquba Teaching Hospital for a period 7 months.Fungal cultures were performed using primary culture onto Sabouraud´s dextrose agar containing chloramphenicol which incubated at 28ºC for 1-2 weeks. The positive results were identified using standard conventional methods. Candida species reportedalmost fungal pneumonia isolated from bronchoalveolar lavage and sinus sites, with a percentage 28.6% and 26.7%, respectively. Whilst, Aspergillus fumigates was the almost fungal isolates from sputum specimens, with a percentage 24%. Young and adult groups were most percentage infected with Candida species (35.7% and 21.1%), respectively. Whilst old aged were most infected with A. fumigates (23.8%) The findings concluded that Candida species and Aspergillusfumigates reported the highest frequency of fungal pneumonia infections. Keywords: Fungal pneumonia, Candida species, Aspergillus fumigates,Respiratory tract infections How to cite this article: Al-Ammari AM, Hussein AF, Ismael TK (2019): Prevalence of fungal pathogens among respiratory tract infections, Ann Trop & Public Health; 22(8): S227. DOI: http://doi.org/10.36295/ASRO.2019.22085 INTRODUCTION Immunocompromised patient is faced with threat of suppression in immune system due to different reasons such as (chemotherapy , AIDS, diabetes, organs transplant and auto immune diseases) (1) ©Annals of Tropical Medicine & Public Health S228 Al-Ammari et al (2019): Fungal Pathogens in RTIs November 2019 Vol. 22(8) One-third of infections associated mortality are caused by respiratory diseases. Among these accounting, fungal respiratory infections are largely unrecognized. Although treatment, most invasive fungal infections stilled responsible forhigh mortality(2,3).Endemic or opportunistic fungi are causes of pulmonary fungal problems. The fungal pathogens are capable to cause opportunistic diseasesin particular in personswhose suppression in immune systems(4). Many of soil-inhabiting fungal genera including (Aspergillus, Blastomyces, Coccidioides, Candida, Cryptococcus, Histoplasma, and Penicillium) which are primarily inflicting lungs and considered to besystemic or opportunistic pneumonia problems(5).Fungal diseases are most increasingly in nosocomial setting. Distribution the spores of fungi are more than 50,000 spores \m3 of air loaded during the fungal season(6,7).Fungal spores are typically enter the lung by inhalation, the spores reach lung through the bloodstream and cause fungal pneumonia. Inside the alveoli, the fungal spores travel throughoutintracellular spaces and also passage to adjacent alveoli through connecting pores. The immune system is respond by sendingWBCs for attacking fungal spores as foreign bodies(8). A studyrevealed thatcertain fungus present in the high percentage in bronchial and sinonasalcultures, even in healthy individuals(9).Fungal pneumonia is more commonly as colonization in both of upper and lower airway allergic diseases particularly in patients with allergic rhinitis, asthma, chronic rhinosinusitis and cystic fibrosis. The recognition between colonization and infection is not easy. Therefore, the antifungal treatment is initiated associated with an increase in adverse events and costs. On the other hand, fungal pneumonia are associated with high percentageof mortality in those cases where treatment initiation is delayed (10). MATERIALS AND METHODS One hundred twenty specimens were collected from randomized patients with respiratory problems who attended Baquba Teaching Hospital for a period7 months.Patients´ age was ranged from 1 to 70 years old. The specimens including bronchoalveolar lavage, sinus, and sputum (40 specimens each). The volume of collected specimenswas approximatelybetween 2-6 ml.Fungal cultures were performed on fresh specimens using primary culture onto Sabouraud´s dextrose agar containing chloramphenicol which incubated at 28ºC for 1-2 weeks. The positive results were identified using standard conventional methods such as Czapic agar, malt yeast agar, potato carrot agar, potato carrot agar, Chrom agar, Tweens assimilation tests, germ tube test, API 20C system, colony morphology and microscopic findings(11). RESULTS Out of one hundred twenty specimens had been included in this survey, the percentages of fungal isolated from respiratory infections were35%, 37.5% and 62.5%, respectively (Table 1). Table 1: Percentage of fungal pneumoniaaccording tospecimen sites Specimens Bronchoalveolar Sinus Sputum Total lavage ©Annals of Tropical Medicine & Public Health S228 Al-Ammari et al (2019): Fungal Pathogens in RTIs November 2019 Vol. 22(8) Results No (%) No(%) No(%) No (%) Positive 14 (35%) 15 (37.5%) 25(62.5%) 54(45%) Negative 26 (65%) 25 (62.5%) 15(37.5%) 66(55%) Total 40(100%) 40 (100%) 40 (100%) 120(100%) Percentage of fungal isolates: Candida species reportedalmost fungal pneumonia isolated from bronchoalveolar lavage and sinus sites, with a percentage 28.6% and 26.7%, respectively. Whilst, Aspergillus fumigates was the almost fungal isolates from sputum specimens, with a percentage 24% (Table 2). Table 2: Percentage of fungal isolates according to infection sites Sites Bronchoalveolar Sinus Sputum Total lavage Results No(%) No (%) No (%) No (%) Absidia species 1 (7.1%) 0(0.0%) 0(0.0%) 1(1.9%) Alternaria species 0(0.0%) 0(0.0%) 1(4%) 1(1.9%) Aspergillus falvus 2 (14.3%) 2 (13.3%) 1(4%) 5(9.3%) Aspergillus fumigates 3(21.4%) 1 (6.7%) 6(24%) 10 (18.5%) Aspergillus niger 0(0.0%) 1 (6.7%) 2(8%) 3(5.6%) Candida species 4(28.6%) 4 (26.7%) 5(20%) 13 (24.1%) Cladosporium species 0(0.0%) 0(0.0%) 1(4%) 1(1.9%) Cryptococcus neoformans 2(14.3%) 2(13.3%) 4(16%) 8(14.8%) Fusarium species 0(0.0%) 1 (6.7%) 1(4%) 2(3.7%) Mucor species 1(7.14%) 2(13.3%) 1(4%) 4(7.4%) Rhizopus species 0(0.0%) 0(0.0%) 1(4%) 1(1.9%) Rhodotorula species 1(7.14%) 0(0.0%) 1(4%) 2(3.7%) Penicillium species 0(0.0%) 2(13.3%) 1(4%) 3 (5.65) Total 14 (100%) 15 (100%) 25 (100%) 54 (100%) Male patients were more infected with fungal pneumonia than females. Candida species reported asa highly infections with fungal pneumonia infection, with a percentage (21.9%)(Table 3). Table 3: Percentage of fungal pneumonia isolates according to sex groups concerning specimens Male Female Specimens Source Total Results No (%) No(%) (No) No (%) Absidia species 1 (3.1%) 0(0.0%) Bronchoalveolar lavage 1(1.9%) Alternaria species 1 (3.1%) 0(0.0%) Sputum 1(1.9%) Bronchoalveolar lavage (2) 5(9.3%) ©Annals of Tropical Medicine & Public Health S228 Al-Ammari et al (2019): Fungal Pathogens in RTIs November 2019 Vol. 22(8) Aspergillus falvus 2(6.3%) 3 (13.6%) Sinus (2)Sputum (1) Bronchoalveolar lavage (3) 10 (18.5%) Aspergillus fumigates 6(18.8%) 4 (18.2%) Sinus (1)Sputum (6) Aspergillus niger 3(9.4%) 0(0.0%) Sinus (1)Sputum (2) 3(5.6%) Bronchoalveolar lavage (4) 13 (24.1%) Candida species 7 (21.9%) 6(27.3%) Sinus (4)Sputum (5) Cladosporium species 1 (3.1%) 0(0.0%) Sputum (1) 1(1.9%) Bronchoalveolar lavage (2) 8 (14.8%) Cryptococcus neoformans 4 (12.5%) 4(18.2%) Sinus (2)Sputum (4) Fusarium species 2(6.3%) 0 (0.0%) Sinus (1)Sputum (1) 2(3.7%) Bronchoalveolar lavage (1) 1(3.1%) 4(7.4%) Mucor species 3 (13.6%) Sinus (2)Sputum (1) Rhizopus species 1(3.1%) 0(0.0%) Sputum (1) 1(1.9%) Bronchoalveolar lavage (1)Sputum Rhodotorula species 1(3.1%) 1(4.6%) 2(3.7%) (1) Penicillium species 2 (6.3%) 1(4.6%) Sinus (1)Sputum (1) 3 (5.65) Bronchoalveolar lavage (14) 54 (100%) Total 32(100%) 22 (100%) Sinus (15)Sputum (25) Upon stratification of patients´ age, young and adult groups were most infected with Candida species, with a percentage 35.7% and 21.1%, respectively. Whilst old aged were most infected with A. fumigates (23.8%) (Table 4). Table 4: Percentage of fungal pneumonia isolates according to age groups concerning specimens Age groups Young Adult Old Sample Source Total Results No (%) No(%) No (%) (No) No(%) Absidia species 0(0.0%) 1(5.3%) 0(0.0%) Bronchoalveolar lavage 1(1.9%) Alternaria species 0(0.0%) 0(0.0%) 1(4.8%) Sputum 1(1.9%) Bronchoalveolar lavage (2) Aspergillus falvus 1 (7.1%) 2 (10.5%) 2(9.5%) 5(9.3%) Sinus (2)Sputum (1) Bronchoalveolar lavage (3) Aspergillus fumigates 2 (14.3%) 3(15,8%) 5(23.8%) 10(18.5%) Sinus (1)Sputum (6) Aspergillus niger 0(0.0%) 1(5.3%) 2(9.5%) Sinus (1)Sputum (2) 3(5.6%) Bronchoalveolar lavage (4) Candida species 5 (35.7%) 4(21.1%) 4(19.1%) 13(24.1%) Sinus (4)Sputum (5) Cladosporium species 1 (7.1%) 0(0.0%) 0(0.0%) Sputum (1) 1(1.9%) Bronchoalveolar lavage (2) Cryptococcus neoformans 2 (14.3%) 3(15,8%) 3(14.3%) 8 (14.8%) Sinus (2)Sputum (4) ©Annals of Tropical Medicine & Public Health S228 Al-Ammari et al (2019): Fungal Pathogens in RTIs November 2019 Vol.
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