In Indoor settings, it is a common practice to prescribe antifungal agents to patients if fungus is identified in their sputum. We planned a prospective study to determine presence of fungus in sputum of patients admitted in pulmonary medicine ward. A total of 61 adult patients, 33 receiving prior antibiotics (for current respiratory infection) and 28 receiving prior inhaled corticosteroids (for asthma/COPD) were evaluated as these are known factors facilitating fungal colonization in airways. 15/28 patients on inhaled steroids had taken additional antibiotics for current illness. Patients with immunocompromised status and oral candidiasis were excluded. A single spot sputum sample was collected in culture bottle and was subjected to testing without delay. Smears showing yeast, yeast like forms, filamentous forms or pseudohyphae on gram stain/ wet mount were considered positive. Growth within one week on Saboraud's dextrose agar slant was considered as culture positive. 14/33(42.42%) of patients receiving prior antibiotics were smear positive and 17/33 (51.51%) were culture positive. 18/28 (64.28%) of patients on inhaled steroids were smear positive and 9/28 (32.14%) were culture positive. Out of 15 patients receiving antibiotics in addition to inhaled steroids, 12 were smear positive (80%) and 3 were culture positive (20%). Commonest fungi grown were Candida spp. and Aspergillus spp. None of the reports correlated clinically since all patients did clinically well without use of antifungal agents. These findings suggest fungal colonization of airways in the patients receiving antibiotics or inhaled steroids and low diagnostic value for identifying fungus in their sputum.
Full conference title:
20th European Respiratory Society conference
- ERS 20th (2010)