Work

Atypical presentation of asthma patients with airway fungal infection presenting with possible pulmonary tuberculosis

Year: 2024

Type: article

Abstract: Background. Low- and middle-income countries, including Sudan, are confronted by the double burden of chronic respiratory diseases and tuberculosis. The presentation of asthma with airway fungal infection can mimic that of pulmonary tuberculosis (PTB), especially in TB endemic countries. Objectives. The study aimed to describe the atypical presentation of asthma with airway fungal infection among patients, some of whom were initially misdiagnosed for PTB, and report their treatment outcomes. Methods. A cross-sectional study was conducted at Abu-Anga Specialized Chest Hospital between January 2017 and December 2019. The study population included asthma patients who tested positive for airway fungal infection (AF) but had negative sputum GeneXpert results for Mycobacterium tuberculosis (MTB), and PTB patients who had positive GeneXpert results for MTB and negative direct smear and culture for fungi. Logistic regression was used to evaluate the association between dependent and independent variables. Results. We recruited a total of 224 patients, including 83 AF patients (mean age 42.2 ± 13.61 years) and 141 PTB patients (mean age 35.4 ± 15.54 years). Females comprised 49.4% of the AF group and 20.6% of the PTB group. PTB radiological features were present in 81.6% of PTB patients versus 9.6% of the AF patients. Among the AF group, fungal culture showed that 20.5% had Aspergillus, and 79.5% had Candida. Wheeze (OR 4.56, 95% CI 2.44-8.55, P<0.001), hemoptysis (OR 3.97, 95% CI 1.99-7.94, P<0.001), and hyperinflation on chest x-ray (OR 16.89, 95% CI 8.28-34.45, P<0.001) were associated with the AF group. The majority of AF patients (90.4%) had favorable treatment outcomes with oral antifungal therapy at 4 months. Conclusion. Asthma with airway fungal infection is underdiagnosed and can be misdiagnosed as PTB, especially in TB endemic settings. Once recognized, satisfactory treatment outcomes could be achieved with the recommended medications.

Source: One health mycology.

DOI: 10.63049/ohm.24.11.5