背景:二向型真菌在孢子吸入肺系统后引起感染。在下呼吸道,分生孢子转化为酵母,它们被肺泡巨噬细胞吞噬,可能在没有疾病表现的情况下被破坏。然而,在一些免疫功能低下的个体中,它们可能持续存在并引起活动性真菌病,其特征是在感染组织中形成肉芽肿,可以模拟结核分枝杆菌(MTB)。
目的:确定坎帕拉穆拉戈国家转诊和教学医院非结核病慢性咳嗽的HIV/AIDS患者中肺部二型真菌感染的患病率,乌干达。
方法:从医院的免疫抑制综合征(ISS)诊所就诊的175名同意的HIV/AIDS患者中收集痰样本。根据XpertMTB/RIF痰液检测,21名患者的MTB检测呈阳性,这些被排除在进一步分析之外。然后在MBN临床实验室对其他154例痰阴性样品进行二态真菌的PCR。使用单重PCR检测每种感兴趣的双态真菌物种的所选相应基因中的靶序列。基于凝胶电泳检测DNA扩增子。
结果:在研究人群中,有16.2%(25/154)检测到了双态真菌。其中9.1%(14/154)有皮肤胚芽,7.1%(11/154)有马尔尼菲塔拉菌。其余84%的研究参与者没有双态真菌。荚膜组织胞浆,在任何参与者中均未检测到球虫和巴西副球虫。
结论:异形真菌(B.在坎帕拉有16.2%的非结核病慢性咳嗽的HIV/AIDS患者中发现了dermatitidis和MarneffeiT.乌干达。我们建议在患有慢性咳嗽的HIV/AIDS患者中对这些病原体进行常规检测。
BACKGROUND: Dimorphic fungi cause infection following the inhalation of spores into the pulmonary system. In the lower respiratory tract, the conidia transform into yeasts, which are engulfed by alveolar macrophages and may be destroyed without disease manifestation. However, in some immunocompromised individuals, they may persist and cause active fungal disease characterized by formation of granulomas in the infected tissues, which may mimic Mycobacterium tuberculosis (MTB).
OBJECTIVE: To determine the prevalence of pulmonary dimorphic fungal infections among HIV/AIDS patients with non-TB chronic cough at Mulago National Referral and Teaching Hospital in Kampala, Uganda.
METHODS: Sputum samples were collected from 175 consented HIV/AIDS patients attending the immuno-suppression syndrome (ISS) clinic at the hospital. Upon Xpert MTB/RIF sputum testing, 21 patients tested positive for MTB, and these were excluded from further analysis. The other 154 sputum negative samples were then subjected to PCR for dimorphic fungi at MBN Clinical Laboratories. Singleplex PCR was used to detect the target sequences in selected respective genes of each dimorphic fungal species of interest. DNA amplicons were detected based on gel electrophoresis.
RESULTS: Dimorphic fungi were detected in 16.2% (25/154) of the studied population. Of these 9.1% (14/154) had Blastomyces dermatitidis and 7.1% (11/154) had Talaromyces marneffei. The remaining 84% of the studied participants had no dimorphic fungi. Histoplasma capsulatum, Coccidioides immitis and Paracoccidioides brasiliensis were not detected in any of the participants.
CONCLUSIONS: Dimorphic fungi (B. dermatitidis and T. marneffei) were found in 16.2% of the HIV/AIDS patients with non-TB chronic cough in Kampala, Uganda. We recommend routine testing for these pathogens among HIV/AIDS patients with chronic cough.