Coexistence of opportunistic mycosis and Mycobacterium tuberculosis in patients attending the Central Tuberculosis Reference Laboratory of Ghaemshahr city, Iran

Introduction: Opportunistic fungal organisms, such as Aspergillus and Candida species, tend to cause diseases in tuberculosis (TB) patients. Respiratory tract mycosis has clinical and radiological characteristics which are very similar to TB, thereby making the disease easily misdiagnosed. TB can be a predisposition to serious opportunistic fungal infections. Prolonged use of anti-TB drugs promotes the growth and reproduction of opportunistic fungi and, in turn, aggravates the course of the underlying process in the lung tissues. The study objective is to determine fungal coexistence with Mycobacterium tuberculosis (MTB) in patients attending the Central Tuberculosis Reference Laboratory of the Health Center in Ghaemshahr city, Iran. Material and Methods: Twenty-five participants were recruited into the study during two months. For each patient, three successive morning samples during one month were collected into sterile wide-neck universal sputum mugs. Specimen collection was taken for analysis at the Laboratory. None of the participants in this study had been placed on anti-fungal therapy. Sputa samples were studied for fungal elements and MTB. Direct microscopy by three stainings – KOH+Calcofluor white, Gomori-methenamine-silver and Giemsa – and fungal culture were done on Sabouraud Dextrose agar. Analysis for acid-fast bacilli (AFB) was done by the Ziehl–Neelsen technique. Results: A total of 75 fresh sputa samples were collected. Branching hyphae in 10 samples of 5 (20%) patients and pseudo-hyphae and blastoconidia in 12 samples of 5 (20%) patients were seen together with TB. Aspergillus flavus and Candida albicans were identified in the culture method and mycological exams. Discussion: Mycotic disease is an important coexistence in patients with TB. Although active mycosis may be an independent marker of advanced immunosuppression, it may also act as a co-factor in accelerating and amplifying the clinical course of TB disease. It is necessary in TB patients to increase the cure rate considering coexistencing opportunistic infections.