Prevalence of Invasive Pulmonary Fungal Infections among Chronic Obstructive Pulmonary Disease Patients in Mansoura University Hospitals

Document Type : New and original researches in the field of Microbiology.

Authors

1 Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Egypt

2 Chest Medicine Department, Faculty of Medicine, Mansoura University, Egypt

3 Pathology Department, Faculty of Medicine, Mansoura University, Egypt

Abstract

Background: COPD is a progressive lung disease marked by chronic respiratory symptoms and persistent airflow restriction.  Exacerbations are acute worsening of symptoms that indicate disease progression and are linked to higher morbidity and death.  COPD affects roughly 300 million individuals worldwide, with an estimated prevalence of 12.2%. Objectives: This study aimed to estimate the prevalence of invasive pulmonary fungal infections (IPFIs) among COPD patients, identify the most common fungal agents, and assess the diagnostic performance of pan-fungal PCR and serum β-D-glucan (BDG). Methodology: Forty-five patients with acute exacerbation of COPD (AECOPD) with clinical suspicion of IPFIs were included. Bronchoalveolar lavage was performed for fungal culture, blood samples were collected for BDG measurement using ELISA and pan-fungal PCR, and transbronchial biopsies were obtained for histopathological analysis. Results: The prevalence of IPFIs using fungal culture as the reference method was 68.9%. Aspergillus spp. were the most common identified fungi, with Aspergillus fumigatus being the most common species (35.6%). Serum BDG testing showed good diagnostic performance, with an AUC of 0.810 and an optimal cutoff value of 114 pg/mL. Fungal culture demonstrated a sensitivity of 100%, specificity of 35.9%, PPV of 19.3%, and NPV of 100% when compared to histopathology. Conclusion: fungal culture is a sensitive method for detecting IPFIs, while histopathology, though specific, may miss some infections. BDG also appears to be a useful biomarker in diagnosing IPFIs among COPD patients.

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