Background
Pulmonary fungal infection (PFI) is increasing among patients with chronic obstructive pulmonary disease (COPD). Survival depends on rapid diagnosis and early treatment.
Aims
To assess the prevalence of PFI in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the clinical, demographic, and radiological findings related to PFI in COPD patients.
Patients and methods
This observational cross-sectional study was conducted on 80 patients with AECOPD. High-resolution computed tomography, fiberoptic bronchoscopy with bronchoalveolar lavage, spirometry, sputum and bronchoalveolar lavage fungal culture and measurements of serum 1, 3 beta-D-glucan (BDG) were done for all patients. They were classified into possible PFI and probable PFI based on the Bulpa and colleagues criteria.
Results
Among the 80 studied patients, 19 patients had possible PFI, and 61 patients had probable PFI; of them 12 patients had positive BDG and 49 had negative BDG. The use of either systemic steroids and/or antibiotics in the last 3 months was higher in patients with probable PFI than those with possible PFI (=0.003). The daily dose (mg/kg) and duration of systemic steroids were higher in patients with probable PFI (=0.001). The use of inhaled corticosteroids (ICS), its dose, and its duration did not differ between both groups.
Conclusion
Probable PFI is prevalent among patients with AECOPD 61 (76.3%); of them 19.7% was invasive form. PFI in AECOPD is related to the use, dose, and duration of systemic steroids and antibiotic use in the last 3 months. Therefore, a lower dose or interrupted course of systemic steroid must be considered in COPD patients.