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Abstract：
BACKGROUND: Pulmonary mycoses resemble clinically and radiologically chronic pulmonary tuberculosis. Studies describing the prevalence, etiology and clinical features of pulmonary mycosis are of crucial importance in the Brazilian Amazon.
OBJECTIVE: To estimate the frequency of pulmonary mycoses in smear-negative tuberculosis patients; to describe their demographic, epidemiological, and clinical characteristics; and to evaluate diagnostic methods.
METHODS: A cross-sectional study was conducted at two tuberculosis reference institutions in Amazonas, Brazil. We included 213 patients and collected clinical data, blood and induced sputum to perform serological, direct microscopy, microbiologic culture and PCR-based assays to identify infections caused by Aspergillus fumigatus, Paracoccidioides brasiliensis, Histoplasma capsulatum, Cryptococcus, and HIV. Chest computed tomography was also performed.
RESULTS: Pulmonary mycoses were diagnosed in 7% (15/213) of the cases, comprising ten aspergillosis cases, three cases of paracoccidioidomycosis and one case each of histoplasmosis and cryptococcosis. Among the patients with pulmonary mycoses, 86.7% were former tuberculosis patients. The most significant clinical characteristics associated with pulmonary mycoses were cavity-shaped lung injuries, prolonged chronic cough and hemoptysis.
CONCLUSIONS: Our study confirmed the high prevalence of pulmonary mycoses in smear-negative tuberculosis patients in the Brazilian Amazon.
OBJECTIVE: To estimate the frequency of pulmonary mycoses in smear-negative tuberculosis patients; to describe their demographic, epidemiological, and clinical characteristics; and to evaluate diagnostic methods.
METHODS: A cross-sectional study was conducted at two tuberculosis reference institutions in Amazonas, Brazil. We included 213 patients and collected clinical data, blood and induced sputum to perform serological, direct microscopy, microbiologic culture and PCR-based assays to identify infections caused by Aspergillus fumigatus, Paracoccidioides brasiliensis, Histoplasma capsulatum, Cryptococcus, and HIV. Chest computed tomography was also performed.
RESULTS: Pulmonary mycoses were diagnosed in 7% (15/213) of the cases, comprising ten aspergillosis cases, three cases of paracoccidioidomycosis and one case each of histoplasmosis and cryptococcosis. Among the patients with pulmonary mycoses, 86.7% were former tuberculosis patients. The most significant clinical characteristics associated with pulmonary mycoses were cavity-shaped lung injuries, prolonged chronic cough and hemoptysis.
CONCLUSIONS: Our study confirmed the high prevalence of pulmonary mycoses in smear-negative tuberculosis patients in the Brazilian Amazon.
摘要：
背景：肺部真菌在临床和放射学上类似于慢性肺结核。描述患病率的研究，在巴西亚马逊地区，肺真菌病的病因和临床特征至关重要。
目的：评估涂片阴性肺结核患者肺部真菌病的发生频率；描述他们的人口统计学特征，流行病学,和临床特征；并评估诊断方法。
方法：在亚马逊地区的两个结核病参考机构进行了一项横断面研究，巴西。我们纳入了213例患者，并收集了临床数据，血液和诱导痰进行血清学，直接显微镜,微生物培养和基于PCR的测定，以鉴定由烟曲霉引起的感染，巴西副球菌，荚膜组织胞浆，隐球菌,和艾滋病毒。还进行了胸部计算机断层扫描。
结果：在7％（15/213）的病例中诊断出肺部真菌病，包括十例曲霉病病例，副球藻菌病3例，组织胞浆菌病和隐球菌病各1例。在肺部真菌病患者中，86.7%为既往肺结核患者。与肺真菌病相关的最显著的临床特征是腔形肺损伤，长期慢性咳嗽和咯血。
结论：我们的研究证实了巴西亚马逊河地区涂片阴性肺结核患者中肺部真菌病的高患病率。
目的：评估涂片阴性肺结核患者肺部真菌病的发生频率；描述他们的人口统计学特征，流行病学,和临床特征；并评估诊断方法。
方法：在亚马逊地区的两个结核病参考机构进行了一项横断面研究，巴西。我们纳入了213例患者，并收集了临床数据，血液和诱导痰进行血清学，直接显微镜,微生物培养和基于PCR的测定，以鉴定由烟曲霉引起的感染，巴西副球菌，荚膜组织胞浆，隐球菌,和艾滋病毒。还进行了胸部计算机断层扫描。
结果：在7％（15/213）的病例中诊断出肺部真菌病，包括十例曲霉病病例，副球藻菌病3例，组织胞浆菌病和隐球菌病各1例。在肺部真菌病患者中，86.7%为既往肺结核患者。与肺真菌病相关的最显著的临床特征是腔形肺损伤，长期慢性咳嗽和咯血。
结论：我们的研究证实了巴西亚马逊河地区涂片阴性肺结核患者中肺部真菌病的高患病率。
