Background Bacteria and viruses have been implicated as a
major cause of chronic obstructive pulmonary disease
(COPD) exacerbations; however, the potential role of fungal
colonization and infection is poorly understood.
Objective The aim of this study was to assess the profile of
pulmonary fungal infection among COPD patients with and
without comorbidities to determine their prevalence, risk
factors, and outcome among those patients.
Patients and methods In this prospective cross-sectional
analytic study, different samples (sputum, bronchoalveolar
lavage, blood, and others) from 177 COPD patients at risk for
pulmonary fungal infection were examined using mycological
analysis (direct microscopy and culture). Bronchoalveolar
lavage and blood samples were examined using the human
1,3-β-D-glucan and galactomannan ELISA tests.
Results The prevalence of pulmonary fungal infection was
significantly higher in COPD patients with comorbidities
(77.8%) versus COPD patients without comorbidities (53.1%)
(P<0.001), with a predominance of Candida and Aspergillus
spp. in both groups. Mechanical ventilation, corticosteroid
therapy, ICU admission, and age were major risk factors for
pulmonary fungal infection in COPD patients with
comorbidities [P=0.012, odds ratio (ODR)=2.23; P=0.028,
ODR=1.99; P=0.025, ODR=1.94; and P=0.034, ODR=
2.60; respectively]. COPD patients with comorbidities had
significantly higher mortality rate (12.3%) compared with
COPD patients without comorbidities (3.1%; P<0.05). Blood
galactomannan antigen was positive in 16 (19.7%) COPD
patients with comorbidities versus seven (7.3%) in COPD
patients without comorbidities (P<0.05).
Conclusion COPD patients with comorbidities had a higher
prevalence of pulmonary fungal infection and higher mortality
rate compared with COPD patients without comorbidities.
Age, mechanical ventilation, corticosteroid therapy, and ICU
admission were independent risk factors for pulmonary fungal
infection in COPD patients with comorbidities.