Co-Infection of Different Mycological Profiles in Active Pediatric Tuberculosis Patients

Author(s):

Shyam Sundar Bera*, Akash Das, Rupa Dasgupta, Tarun kumar Pathak, Devnil Pathak, Barnali Das, Rajdeep Paul and Debabrata Das

Background: Fungal elements can cause rigorous difficulty; generally in pediatric sufferers that have stumpy immunity to prolonged treatment of pulmonary tuberculosis. Many clinicians some time disregard fungal pulmonary infection, but it has a specific clinical manifestation for treatment purpose so that fungal pathogen can cause severe complication in treatment process in MDR tuberculosis.

Aim: The aim was to identify different overlapping mycological coinfection during the treatment process of a pediatric pulmonary tuberculosis patients and know the prevalence rate.

Method: The present study was conducted among 133 pediatric pulmonary tuberculosis patients with a subdivided groups of MTB and MTB-Rif and two specific age groups wise from Feb, 2020 to Oct, 2022 at Debra Super specialty Hospital, WB. Morning sputum samples were collected in a wide mouth sterile containers and then confirmed tuberculosis by TRUE-NAT (comprehensive assay for screening and confirmation of MTB and MTB-Rif). Then after confirmation of tuberculosis, during the treatment time, another repeated BAL (Bronchio Alveolar Lavage) samples were collected for presumptive diagnosis of fungal pathogen by using the preparation of KOH, gram stain, SDA culture and LPCB mount.

Results: Aspergillus niger showed high percentage in pulmonary tuberculosis of pediatric patients than other fungal elements for both MTB and MTB-Rif patients. 18.4% of A.niger saw 11-15 years of age group and 13.1% seen in between 4-10 years of age group in male patients. Similarly, 7.8% in 4-10 years age group and 10.5% in 11-15 years of age group found A. niger in female patients with MTB pediatric patients. Only 33.3% A.niger was seen in females in the particular age group of 4-10 years in MTB patients and 66.6% was seen in male patients in MTB- Rif patients in particular age group of 11-15 years. Aspergillus fumigates was seen 7.8% in males and 5.2% in females in the age group of 11-15 years in MTB patients but such fungal agent was not seen in MTB-Rif patients. Maximum percentage of A. flavus was seen in 5.2% and H. capsulatum 2.6% in different two-separated age groups. Cryptococcus neoforman was showed 5.2% in MTB patients.

Conclusion: Mycological agents can cause harmful effecst on MTB and MTB-Rif treating patients. In that situation, only treatment of pulmonary tuberculosis is not a prior step for improvement MTB or MTB-Rif. Clinicians should take instant action against fungal pathogens causing harm in an active pulmonary pediatric tuberculosis patients and without clinician advice should not take any medicine; otherwise tubercle bacilli can cause genetic changes, due to the effect Multiple Drug Resistant Tuberculosis (MDR-TB) or Extensively Drug Resistant Tuberculosis (XDR-TB). Therefore, this presents a need for routine diagnosis of pulmonary mycosis among TB suspects and set-up of an antimicrobial profile for pulmonary fungal isolates to support clinical management of these cases.