Prevalence and pattern of isolated fungi from bronchoalveolar lavage among patients with lung cancer: a prospective cross-sectional study

Abstract Background Fungal colonization or infection has recently been reported in patients with lung cancer, and it is possible that it has a role in the pathogenesis of lung cancer or having an effect on treatment and outcome. Aim of work was to assess the prevalence and pattern of isolated fungi from patients with lung cancer at the time of diagnosis. In this prospective cross-sectional observational study, patients with suspected lung tumors were subjected to fiberoptic bronchoscopy (FOB) for biopsy, bronchoalveolar lavage (BAL) with its culture for fungal growth. After a pathological diagnosis, 100 cases of confirmed lung cancer were entered into the study analysis. The prevalence and type of isolated fungi have been determined and compared to the characteristics of the participants and cell types of lung cancer. Results Fungi were isolated from 68% of the studied lung cancer cases. The most common isolated fungi were Candida albicans (32%), Aspergillus niger (28%), and Aspergillus fumigatus (8%). Fungi were isolated with a higher frequency in lung cancer cases with the following characteristics: males (p = 0.008), current or ex-smokers (p = 0.002), and chronic obstructive pulmonary disease (COPD) association (p = 0.01). In comparison to lung cancer cases with negative fungal culture, detection of fungal colonization was more associated with increasing severity of clinical presentation: higher grades of dyspnea (grade 1 vs. grade 2, p 0.001), a higher cough score (score 1 versus score 3, p 0.001), a higher chest pain score (score 0 versus score 1, p 0.001), and higher scores of hemoptysis (score 0 versus score 3, p 0.001). Otherwise, no difference was detected regarding age, frequency of comorbidities, chest computed tomography (CT) findings, lung cancer cell type, and staging in lung cancer patients with fungal colonization (p > 0.05). Conclusion Fungi were isolated in more than two thirds of lung cancer cases at the time of diagnosis with higher frequency among males, smokers, and those having associated COPD. This may negatively affect the response to treatment and prognosis of lung cancer. ClinicalTrials.gov (NCT 05575388).