Positivity rate of Aspergillus spp. in patients with tuberculosis-like symptoms in Yaoundé, Cameroon and antifungal resistance profile

Abstract

BACKGROUND: Pulmonary aspergillosis represents a significant public health concern resulting from the proliferation of Aspergillus species within the respiratory tract. This infection is frequently underdiagnosed in comparison to tuberculosis during the management of pulmonary infections, especially among individuals living with HIV. The objective of this study was to determine the positivity rate of Aspergillus spp. from sputum and bronchoalveolar lavage (BAL) samples of patients presenting with tuberculosis-like symptoms at Jamot Hospital in Yaoundé, Cameroon, and to evaluate their antifungal resistance profiles. METHODS: A total of 114 samples (104 sputum and 10 bronchoalveolar lavage) were collected for mycological analysis. Data were verified, coded, and analyzed using StatView v5.0 and GraphPad v8.0.2 for Windows. Pearson's chi-square test of independence and multivariate logistic regression models were used to compare percentages, with p < 0.05 considered statistically significant. RESULTS: Aspergillus spp. were detected in 12.3% of samples, with two species identified. Aspergillus niger was predominant (57%0), followed by Aspergillus flavus (29%). A. niger isolates tested (5) exhibited resistance to polyenes, with 80% resistant to amphotericin B and 40% to nystatin, and 20% resistant to the azole fluconazole. All A. niger isolates were susceptible to econazole and clotrimazole. Among the five A. flavus isolates tested, all demonstrated resistance to amphotericin B and fluconazole, 60% to nystatin, and 20% to clotrimazole. CONCLUSION: Aspergillus spp. is present in the respiratory tract but often overlooked, and can lead to a misdiagnosis of tuberculosis. Although the very small number of isolates tested, Aspergillus spp. could be also affected to the antimicrobial resistance observed in recent years.