Mycological Profile Of Pulmonary TB-HIV Co-Infected Patients With A Relationship To CD4 Count Levels In A Tertiary Care Hospital of Southern Odisha, India.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2017, Vol 2, Issue 6
Abstract
Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in both the diagnosis and treatment of tuberculosis. This co-infection leads to further immunosupression predisposing to many opportunistic infections including fungal infections. The range of illness varies from asymptomatic mucosal candidiasis to overwhelming disseminated infections. Data on the pattern of opportunistic pulmonary mycoses and the immunological profile of TB-HIV co-infected patients in southern Odisha are scarce, so we investigated respiratory mycoses and CD4 count among pulmonary TB-HIV coinfected patients attending the Integrated Counseling And Testing Centre of MKCGMC, Berhampur, Odisha. Aims and objectives To detect the opportunistic fungal infections occurring in HIV- Pulmonary TB coinfected patients with LRTI and correlate the fungal isolates with CD4 count. Materials and methods This was a prospective study conducted from March 2017 – August 2017, on 50 pulmonary TB- HIV co-infected patients who attended the Integrated Counseling And Testing Centre of MKCGMC, Berhampur, Odisha. Two separate early morning samples were collected 3 days apart from individual patients and were processed for isolation and identification of fungal species. CD4+T lymphocyte count estimation was done by BD FACS COUNTER. Results From the 50 samples fungus was isolated from 36 cases(72%), the most common isolate being Candida albicans (26%) followed by Aspergillus niger(16%) and Aspergillus flavus(10%). Non Albicans Candida were isolated from a significant number of cases 24% in our study. Majority of yeasts were isolated from patients with CD4+T lymphocyte count less than 200 cells/mm3 and moulds and mucormycetes were isolated from patients with CD4+T lymphocyte count less than 100 cells/mm3. Conclusion Finding from this study revealed opportunistic pulmonary mycoses arise frequently from TB- HIV co- infected patients with lower CD4+T lymphocyte counts. A high level of clinical suspicion for fungal etiology of respiratory infections in TB-HIV co-infected patients should be kept in mind and routine management of pulmonary mycoses in TB-HIV co-infected patients should include management of the fungal isolates with a correlation to their CD4 count.
Authors and Affiliations
Dr Abhishek Padhi
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