Clinical Correlation and Analysis of Fungal Co-Infections in Pulmonary Tuberculosis Patients

Abstract

Background: Pulmonary tuberculosis (TB) continues to be a major global health issue, particularly in low- and middle-income countries. Although bacterial co-infections in TB patients are well-documented, fungal co-infections remain less explored. These co-infections can potentially complicate TB treatment and adversely affect patient outcomes.

Objective: This study aims to investigate the prevalence, clinical characteristics, and outcomes of fungal co-infections in patients with pulmonary TB. We seek to identify the most common fungal pathogens associated with TB, analyze the risk factors for these co-infections, and evaluate their impact on TB treatment and patient prognosis.

Methods: We conducted a prospective observational cohort study over two years at several tertiary care hospitals and TB clinics. The study included 500 adult patients diagnosed with pulmonary TB. Patients were selected based on specific inclusion criteria, and those with prior antifungal treatment or unrelated immunodeficiencies were excluded. Clinical data, including demographic information, medical history, and TB disease characteristics, were collected. Sputum samples were obtained at baseline and follow-up intervals and tested for fungal pathogens using culture, polymerase chain reaction (PCR), and serological methods. Radiological assessments and clinical outcomes, including sputum conversion rates, treatment failure, relapse rates, length of hospital stay, and mortality, were also evaluated.

Results: The study found that 20% of pulmonary TB patients had fungal co-infections. Aspergillus spp. was the most common fungal pathogen, followed by Candida spp., Cryptococcus neoformans, Histoplasma capsulatum, and Pneumocystis jirovecii. Patients with fungal co-infections experienced significantly delayed sputum conversion, higher treatment failure rates, and increased mortality compared to those without fungal co-infections. Risk factors for fungal co-infections included advanced age, smoking history, diabetes mellitus, low body mass index (BMI), and a history of previous TB. Multivariate analysis confirmed these factors as significant predictors of fungal co-infections and poor treatment outcomes.

Conclusion: Fungal co-infections are prevalent and clinically significant in patients with pulmonary TB. They are associated with worse treatment outcomes, including delayed sputum conversion, higher treatment failure, and increased mortality. The findings suggest that routine screening for fungal pathogens and consideration of antifungal therapy in high-risk TB patients could improve clinical management and patient outcomes. This study underscores the need for enhanced diagnostic and therapeutic strategies to address fungal co-infections in the context of TB.