Prevalence of Pulmonary Aspergillosis Among Chronic Lung Disease and Lung Cancer Patients with Reference to Clinico-Diagnostic Marker

Background: Invasive Aspergillosis is the most common opportunistic invasive mycoses. There is high prevalence of chronic lung diseases and lung cancers in our country. Objectives: The present study was undertaken to determine the prevalence of Aspergillosis in patients suffering from chronic lung diseases and primary or metastatic lung cancer, to evaluate various clinico-diagnostic markers of pulmonary Aspergillosis and to study the antifungal susceptibility pattern of Aspergillus isolates. Methods: The present study was conducted on 60 patients with chronic lung disease on whom bronchoscopy was performed. Histopathologic and radiological examination was done to identify carcinoma cell types and to categorize Aspergillosis types. Broncho alveolar lavage (BAL) fluids were collected for direct fungal examination, culture, Aspergillus polymerase chain reaction (PCR), and galactomannan (GM) detection and the antifungal susceptibility pattern of Aspergillus isolates was observed. Results: Prevalence of Aspergillosis in patients of lung carcinoma was 32.5%. Aspergillus fumigatus was the predominant species isolated. Gutka chewing have significant role in predisposition to aspergillosis. Higher prevalence of galactomannan antigen was found in lung carcinoma as compared to other chronic lung diseases. 13.3% patients were of proven IPA, 15% of probable IPA, 6.6% belonged to possible IPA while 65% were of non IPA. Aspergillus DNA was detected in 41.6%. Isolates of Aspergillus spp. were most sensitive to Caspofungin, Amphotericin B, Ketoconazole and least to Itraconazole in that order according to Antifungal susceptibility using micro broth dilution method. Disk diffusion method of antifungal susceptibility showed highest resistance to Itraconazole and least to Caspofungin. Conclusions: Higher prevalence of antigen was found in lung carcinoma as compared to other chronic lung diseases. This frequent association of Aspergillosis in lung carcinoma is quiet alarming, and we suggest that every patient with bronchogenic carcinoma should be screened for the presence of secondary Aspergillosis. Thus, early diagnosis of secondary Aspergillosis in such patients may be of great importance, because early antifungal treatment is associated with an improved outcome.