Clinico-microbiological profile of chronic pulmonary aspergillosis from a tertiary care centre in Southern India

Background: Pulmonary aspergillosis is commonly seen in immunocompromised individuals. A significant rise has been seen in these cases in the past decade, owing to growing number of patients with impaired immune status. Aim: This study includes the detailed clinical and microbiological profiles of all the culture positive cases of pulmonary aspergillosis, detected in three years, from Jan 2008-Dec 2010, at our tertiary care centre. Methods: A hospital based observational and retrospective study was conducted to study the clinico-microbiological characteristics of patients with pulmonary aspergillosis. Respiratory specimens which showed repeated isolation of Aspergillus were included in the study. Demographic details, clinical findings and predisposing factors were noted down for all the patients. Treatment of patients with antifungal agents and their responses to treatment were also documented. Results: There were 22 patients with male to female ratio of 1.2:1 and mean age of 52.5 years. The most common underlying lung disease was presence of bronchial asthma in 27.3% (6/22) cases. Many patients (40.9%; 9/22) were on steroid treatment. Cough with expectoration was the most common symptom observed in 72.7% (16/22) cases. Microbiologically, microscopy showed positivity for the presence of gram positive, acutely branched, fungal hyphae, suggestive of Aspergillus, in all the cases. Aspergillus fumigatus was the predominant species that was isolated in 40.9% (9/22) cases. All the diagnosed patients were given either oral itraconazole or intravenous amphotericin B. A clinical improvement was observed in 72.5% (16/22) cases, but 27.3% (6/22) patients died. Conclusion: Pulmonary aspergillosis presents with non-specific clinical and radiological findings. An early suspicion and diagnosis is essential, especially in patients with underlying lung disease, to prevent dissemination and invasion.