A STUDY OF THE PREVALENCE OF PULMONARY FUNGAL COLONIZATION IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Abstract

Introduction: Chronic obstructive Pulmonary Disease (COPD) is a common preventable and treatable disease. Exacerbations are frequent events in the natural history of the disease. The rate of fungal infection in COPD has shown an upward tendency in recent times. Also, it brings a serious threat to these patients.Aim:To study the prevalence of pulmonary fungal colonization and to identify any association between fungal colonization with clinical manifestations in acute exacerbation of COPD. Methodology: Hospital based prospective, observational study was done from 1st July 2015 to 30th June 2016. Clinical data and fungal culture reports of patients with acute exacerbation of COPD were collected. Results: 103 patients were assessed. Mean age was 61.39±11.88 years. Males were 59.22%. Mean duration of disease was 63.34 months with 7.41 days of acute symptoms. Out of 103 patients, 64.08% were smokers, 41.75% had exposure history to indoor pollution and 8.74% had diabetes. Cases with history of inhaled steroids were 38.83%. Fungal growth in sputum was seen in 33.98%. Out of these, 77.14% were Candida albicans, 5.71% C glabrata, 2.86% C krusei and 2.86% C tropicalis. Fungal drug sensitivity reports showed resistance to Fluconazole was 37.14%, Itraconazole 2.86%, Voriconazole 2.86% and Amphotericin B 5.71%. In cases with fungal growth, mean duration of acute symptoms was 11.03 days compared to 5.54 days in cases without fungal growth (p<0.001). Severity according to GOLD criteria were mild (0%), moderate (34.29%), severe (51.43%), very severe (14.29%) in cases with fungal growth, and mild (7.35%), moderate (54.41%), severe (30.88%) and very severe (7.35%) in patients without fungal growth (p<0.05). Conclusion: The prevalence of fungal colonization in acute exacerbation of COPD was 33.98%. The duration of acute symptoms and severity of the disease were statistically signicant in the patients with fungal growth in sputum. Hence fungal culture is recommended in all patients of COPD with acute exacerbations