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Atypical presentation of asthma patients with airway fungal infection presenting with possible pulmonary tuberculosis

Rashid Osman1, Rasheeda H. Abdalla2, Rahma H. Ali2, Muatsim A.M. Adam2, Adel H. Elduma2, Nuha Y.I. Mohamed2, Rania H. Al-Amin1, Mawahib A.M.I. Ismail3, David W. Denning4, Hamdan M. Hamdan1,5

1National Tuberculosis Program, Federal Ministry of Health, Khartoum, Sudan; 2Tuberculosis Reference Laboratory, National Public Health Laboratory, Khartoum, Sudan; 3Microbiology Department, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; 4Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England; 5Abu-Anga Specialized Chest Hospital, Khartoum, Sudan

Abstract

Background. Low- and middle-income countries, including Sudan, are confronted by the double burden of chronic respiratory diseases and tuberculosis. The presentation of asthma with airway fungal infection can mimic that of pulmonary tuberculosis (PTB), especially in TB endemic countries.  
Objectives. The study aimed to describe the atypical presentation of asthma with airway fungal infection among patients, some of whom were initially misdiagnosed for PTB, and report their treatment outcomes.
Methods. A cross-sectional study was conducted at Abu-Anga Specialized Chest Hospital between January 2017 and December 2019. The study population included asthma patients who tested positive for airway fungal infection (AF) but had negative sputum GeneXpert results for Mycobacterium tuberculosis (MTB), and PTB patients who had positive GeneXpert results for MTB and negative direct smear and culture for fungi. Logistic regression was used to evaluate the association between dependent and independent variables.
Results. We recruited a total of 224 patients, including 83 AF patients (mean age 42.2 ± 13.61 years) and 141 PTB patients (mean age 35.4 ± 15.54 years). Females comprised 49.4% of the AF group and 20.6% of the PTB group. PTB radiological features were present in 81.6% of PTB patients versus 9.6% of the AF patients. Among the AF group, fungal culture showed that 20.5% had Aspergillus, and 79.5% had Candida. Wheeze (OR 4.56, 95% CI 2.44-8.55, P<0.001), hemoptysis (OR 3.97, 95% CI 1.99-7.94, P<0.001), and hyperinflation on chest x-ray (OR 16.89, 95% CI 8.28-34.45, P<0.001) were associated with the AF group. The majority of AF patients (90.4%) had favorable treatment outcomes with oral antifungal therapy at 4 months.
Conclusion. Asthma with airway fungal infection is underdiagnosed and can be misdiagnosed as PTB, especially in TB endemic settings. Once recognized, satisfactory treatment outcomes could be achieved with the recommended medications.

Open Access

Cite this article :
Osman R, Abdalla, Ali RH, Adam MAM, Elduma AH, Mohamed NYI, Al-Amin RH, Ismail MAMI, Denning DW, Hamdan HM. 2024 Atypical presentation of asthma patients with airway fungal infection presenting with possible pulmonary tuberculosis. One Health Mycology 1(1), 37-46

ISSN: 3050-4627
doi.org/10.63049/OHM.24.11.5

Keywords: Chronic respiratory disease; fungal asthma; airway mycosis; pulmonary tuberculosis; low- and middle-income countries

Article highlights:

  • The clinical presentation of patients with asthma and fungal infection of the airways can mimic that of pulmonary tuberculosis, leading to potential misdiagnosis. 
  • However, once correctly identified, these patients can achieve satisfactory treatment outcomes. 

#Correspondence: rashidosmankk@gmail.com

Article info:
Received 16 May 2024
Revised 25 June 2024
Accepted 25 June 2024
Appeared online 12 July 2024
One Health Mycology 1(1): 37−46, 2024