European Journal of Cardiovascular Medicine

Chronic pulmonary aspergillosis (CPA) is one of the most frequent lung fungal infections, although many of them mimic pulmonary tuberculosis (PTB). In recent decades, pulmonary fungal diseases have gained therapeutic significance.^[1] WHO (2019) estimates that 10.0 million individuals contracted TB globally in 2018 and that 1.4 million people died from the disease.^[2] Pulmonary tuberculosis (PTB) has been linked to a number of conditions up to this point, including HIV infection, malignancy, undernutrition, diabetes, smoking, alcohol usage, and transplant patients.^[3-9] Aspergillosis is also largely preceded by immune-compromised status, and the risk factors listed above—such as HIV infection, cancer, and smoking—also contribute to the development of invasive aspergillosis (IA) and have been studied in a number of studies.^[10—13] However, lung cavities are typically the outcome of prior tuberculosis (TB), and these residual cavities then harbor Aspergillus infections. As a result of inhaling airborne fungus spores, pulmonary aspergillosis subsequently arises. This implies that patients with retreatment TB have a significant chance of getting IA. ^[14] In people with impaired immune systems, IA is a prevalent infection. IA is still a dangerous and sometimes fatal opportunistic infection even with advancements in treatment. Numerous studies from many nations have reported on the incidence of aspergillosis complicating tuberculosis (TB), and the findings showed that the prevalence varied greatly and might reach 25% in instances of active TB. ^[15-19] Furthermore, a recent meta-analysis found that individuals with pulmonary tuberculosis in Asia and Africa had a pooled rate of Aspergillus coinfection of 15.4%. ^[20]

This study included 100 consecutive sputum samples with proven PTB between 12.7.203 and 7.12.23. Data were taken from medical records, including demographics and underlying medical conditions. In suspected IA cases samples were cultured on two Sabouraud agar plates separately and incubated at 37 and 45°C for up to 5 days.  smoky green, velvety to powdery, reverse is white, yellow green, velvety, reverse is white and black, cottony type, reverse is white on SDA was identified as A. fumigates, A. flavus and A. niger respectively. Slide culture followed by lacto phenol cotton blue mount used to study morphological features of Aspergillus isolates.

During the study period from 12.7.2023 to 17.12.23, 100 sputum samples positive for pulmonary tuberculosis were included in this study. Patients taking any antifungal drug were excluded from the study.  Out of 100 sputum sample, 8 % (8/100) (TABLE :1, FIGURE: 1) pulmonary tuberculosis patients were found infected with pulmonary Aspergillosis of which A.fumagatus , A.flavus and A.niger were 4 , 3 and 1 respectively (TABLE:2). Among the gender of patients 4 male and 4 female were found infected with pulmonary Aspergillosis (TABLE 3, FIGURE 2).  Among the age group of patients < 20, 21-50 and > 50 were 4  , 3 and 2 respectively , out of 8  Aspergillus isolates , 4 female , 2 male  were isolated from <20 years , 21-50 years and >50 years age group whereas no male and no female were found infected with Aspergillus species ,<20 , 21- 50, >50 years age group. (TABLE 4, FIGURE 3)

One significant co-infection in patients with  PTB is pulmonary aspergillosis. While active pulmonary Aspergillosis might be a useful indicator of severe immunosuppression on its own, it might also contribute to the acceleration and exaggeration of PTB illness. With co-existing opportunistic infections, it is imperative to improve the cure rate in PTB patients. According to current study  8% (8/100) pulmonary tuberculosis patients were co-infected with pulmonary Aspergillosis. A similar study done by Ocansey K B et al also showed 9.7% patients of pulmonary tuberculosis found infected with pulmonary tuberculosis.^[21] Another stuby by Oladele RO et al showed 8.7% of PTB infected with pulmonary Aspergillosis.^[22]

Our data demonstrated that the prevalence of IA is 8% in active PTB patients. Pulmonary Aspergillosis is more dangerous when it is associated with some finding like cavities on chest radiograph and some specific underlying diseases, are encountered in a suspected TB patient, we emphasize that further investigations are required, and empirically treatment for IA might be warranted.

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