A recent study published in the Journal of Fungi reveals that patients with multi-drug-resistant tuberculosis (MDR-TB) in Indonesia are at a significantly higher risk of co-infections with chronic pulmonary aspergillosis (CPA) and chronic pulmonary histoplasmosis (CPH). This is the first research into the incidence of CPA as a co-infection of MDR-TB patients in Indonesia in tandem with anti-Histoplasma IgG and CPH.
This study, led by Noni Soeroso, marks a crucial step in understanding the complex relationship between fungal infections and MDR-TB, which has important implications for patient treatment and outcomes.
The project examined 50 MDR-TB patients at Adam Malik Hospital in Medan, North Sumatra. Of this cohort, 28% tested positive for Histoplasma antibodies, indicative of CPH, and 32% had antibodies against Aspergillus, suggesting CPA. Alarmingly, 12% of the patients tested positive for both types of fungal infections. These findings underscore the need for comprehensive screening and management strategies for fungal infections in TB patients to improve prognosis and reduce mortality.
Historically, MDR-TB has been associated with severe lung damage, including cavitation, which can provide a conducive environment for fungal infections. The study confirmed that patients with fungal co-infections displayed worse radiological outcomes, such as advanced cavitation and pleural thickening, compared to those without fungal infections. Notably, 15.3% of patients with both TB and fungal infections died within the first five months of the study, compared to no deaths among those with only MDR-TB.
The study also explored potential risk factors for these fungal infections. It found that patients living in damp housing conditions were twice as likely to have Histoplasma antibodies, while those who kept pets were 18 times more likely to have Aspergillus antibodies. These findings point to the influence of environmental and lifestyle factors on the susceptibility to fungal infections among MDR-TB patients.
Fig. 1 – Chest X-ray example in cases of chronic pulmonary histoplasmosis and aspergillosis: example of a far-advanced radiological finding.
The coexistence of TB with CPA and CPH presents significant challenges for diagnosis and treatment. The overlapping symptoms, such as chronic cough, weight loss, and fever, often lead to misdiagnosis, and the standard TB treatments may not be effective against fungal infections. Moreover, certain antifungal treatments can interact adversely with TB medications, complicating the treatment protocols.
The study’s authors advocate for the integration of fungal infection screening in the standard diagnostic procedures for MDR-TB patients. This approach could lead to more timely and accurate diagnoses, ensuring that patients receive appropriate treatment for both TB and associated fungal infections. Additionally, public health interventions to address environmental risk factors, such as improving housing conditions, could play a crucial role in reducing the incidence of these co-infections.