Pulmonary dimorphic fungal infections in HIV infected patients with NON-TB chronic cough at Mulago Hospital, Uganda

Abstract

Introduction: Dimorphic fungi cause infection following inhalation of spores (conidia) into the pulmonary system. In the lower respiratory tract the conidia transform into the yeast phase which are engulfed by alveolar macrophages and may be destroyed without disease manifestation in healthy immune competent hosts. However, in some cases they may persist and cause fungal disease characterized by formation of granulomas in the infected tissues, which may mimic MTB. Dimorphic fungi of medical importance include Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Paracoccidioides brasilience and Penecillium Marneffei. This study, therefore, set out to determine the role of dimorphic fungi role in pulmonary disease HIV/AIDS patients with chronic cough at Mulago Hospital Uganda. Methods: This was a cross-sectional study conducted from July 2020 – Feb-2021 at ISS Clinic Mulago and MBN Clinical Laboratories, One hundred and seventy five (175) HIV infected patients with chronic cough were consecutively selected. Upon Xpert/RIF test at ISS Clinic 21 participants were positive and 154 turned out negative. The 154 sputum samples that tested negative were then tested for dimorphic fungi at MBN Clinical Laboratories. Singleplex PCR was used where specific primers were used to detect a target sequency in the gene of particular dimorphic fungi, the resulting amplicons were electrophoresed on a 2% gel then visualized under UV light. Data analysis was then done using SPSS and STATA. Results: Blastomyces dermatitidis and Tarolomyces marneffei were detected in 16.4 % of the studied participants, with 9.1% and 7.1% respectively and 83.8% of the participant sample had no dimorphic fungi. Coccidiodes immitis, Paracoccidiodes brasiliensis and Histoplasma capsulatum were not detected in any of the participants. Conclusion: This study has shown that dimorphic fungi play a role in pulmonary disease among the HIV/AIDS with non- TB chronic in Uganda. We recommend patients of chronic cough who are TB negative to be investigated for dimorphic fungal infections as well.