Fungal Isolates of the Respiratory Tract in Symptomatic Patients Hospitalized in Pulmonary Units: A Mycological and Molecular Epidemiologic Study

Figures & data

Table 1 GenBank Accession Numbers of DNA Sequences Included in This Study

Fungal Elements	GenBank Accession Numbers Used in the Sequence Analysis
Candida albicans	MK793223, MN419311, MN394878, MK138363, MH729024, KX355315, MG020722, KP674532, GQ280312, KC905076, HE860439, JN606216, AB369945, MK113223, JN606273, JN60625, AB018037, AB018038, LC522889, LC522889, MH016316,KY101869, KY101873, KY101874, KY101875, KY101901, KY101906, MG913256, KY996543, MF614746,MF614741, MF614725, MF614723, JN882314, JN882321, GQ376070, EF192231, AF455428, MN318604, MH729028, KC905069, MG818819, MG818824, KY996544, KY996539, MH016327, MH016296,MH734813,MH729024,MG599201,MN4193373,MN419366, MH918807, MK307750, GQ280305, GQ849400, EF568101, JX406290, KU095860,AB436996
Candida tropicalis	MK793225, MT028124, MN919090,MN796064, MG009522, MK547223, HM231275, GQ376071, EU924133, AY939810, MH534930, MH534908,MG720231, KU950724, GQ376071, EU924133, KU987879, KM361510, MH545915, MK394119, MH591472, MH260384, KX198669, KJ451708, KJ451647, KF746430, KF746416, EU288196, KJ451642, KC254014,
Candida glabrata	FN652301, GQ376080, AM492798, AM492797, MK793223, KU99239, KU992391, KU992392, KU992393, LC317498, FN652301, LS398111, LC311497, LR757911, KP131708, LR757911, FN652302, HE993756, LS398123, LC317498, FN652301, AY939793
Candida krusei	MH545928, FJ515204, JX174414, MK394162, LC389008, KF959838, MH545928, MN310532, MK894151
Candida parapsilosis	MK394127, KY102205, KP131738, LN864530, MG241512, LC317527, DQ681358, EU564209
Rhodotorula mucilaginosa	KT876599, MN913572, KT87670, KP960513, MN427959
Trichosporon asahii	MN809474, AB018013, AB018014
Geotrichum candidum	MH443758, KX928847, MK499446
Aspergillus flavus	MK119732, AY017536, M38265
Rhizopus oryzae	LC514310
Aspergillus niger	LC387867
Aspergillus fumigatus	MH781327
Alternaria alternata	MK793206

Table 2 The Distribution of 137 Symptomatic Patients Hospitalized in Pulmonary Units from Which Fungal Agents Were Isolated Based on Age Groups, Gender and Underlying Diseases

			Patients					P-value ^a
			Number		Percentage
	1–45		33		24.08
Age groups (years)	46–72		75		54.74			0.546
	73–86		29		21.16
	Female		86		62.77
Gender								0.8111
	Male		51		37.23
	Tuberculosis		34		24.81
	Solid tumors	Breast cancer		9		6.56
		Prostate cancer		7		5.1
		Ovarian cancer	30	6	21.86	4.37
		Lung cancer		4		2.92
		Esophageal adenocarcinoma		3		2.1
		Osteosarcoma		1		0.72
	Diabetes mellitus		27		19.70			<0.001
	Kidney failure		10		7.29
	Heart failure and hypertension		10		7.29
Underlying diseases	Respiratory failure		10		7.29
	Autoimmune diseases	Rheumatoid arthritis		3			2.18
		Multiple Sclerosis	8	2	5.83		1.46
		Systemic lupus erythematosus		2			1.46
		Pemphigus vulgaris		1			0.72
	Without underlying disease		4		2.92
	Iron deficiency anemia		2		1.46
	AIDS		1		0.72
	Asthma		1		0.72
Total			137		100

Note: ^aP-value, probability value.

Abbreviation: AIDS, acquired immunodeficiency syndrome.

Table 3 The Frequency Distribution of Fungal Elements Isolated from 137 Positive Cases Hospitalized in Pulmonary Units

Isolated Fungi	Frequency	Percent
Candida albicans	51	37.22
Candida tropicalis	30	21.89
Candida glabrata	17	12.4
Candida krusei	8	5.83
Candida parapsilosis	7	5.1
Candida glabrata+ Candida albicans	5	3.56
Rhodotorula mucilaginosa+Candida albicans	4	2.92
Trichosporon asahii	3	2.18
Geotrichum candidum	3	2.18
Aspergillus flavus	3	2.18
Rhizopus oryzae	1	0.72
Aspergillus niger	1	0.72
Aspergillus fumigatus	1	072
Alternaria alternata	1	0.72
Candida krusi + Candida parapsilosis	1	0.72
Rhodotorula mucilaginosa +Trichosporon asahii	1	0.72
Total	137	100

Table 4 Detailed Information of Each Patient Involved with Invasive Pulmonary Aspergillosis Categorized Based on EORTC/MSC (2019) Criteria

Patient Number	Age (Years)	Gender	Underlying Diseases	Symptoms	GM Level in BAL Specimen	CT Scan	Direct Examination	Culture and Molecular Detection	Antifungal Given for Curative Intent	Outcome	IPA
1	30	Male	AIDS	Cough, dyspnea, weight loss	1.1	–	Branching septate hyphae	Aspergillusfumigatus	Voriconazole + caspofungin	Under treatment	Possible
2	53	Male	Lung cancer	Recurrent fever, chest pain, cough	2.3	Nodular lesions	Branching septate hyphae	Aspergillusflavus	Amphotericin B + voriconazole	Treated	Probable
3	35	Female	Systemic lupus erythematosus	Cough, dyspnea, Purulent sputum	0.7	–	Branching septate hyphae	Aspergillusflavus	Amphotericin B + voriconazole	Treated	Possible
4	63	Female	Breast cancer	Cough, Purulent sputum, dyspnea	0.6	–	Branching septate hyphae	Aspergillusniger	Liposomal amphotericin B	Treated	Possible
5	71	Male	Prostate cancer and tuberculosis	Hemoptysis,dyspnea, chest pain	2.1	Cavity	Branching septate hyphae	Aspergillusflavus	Amphotericin B + voriconazole	Treated	Probable

Abbreviations: EORTC/MSC, European Organization for Research and Treatment of Cancer and Mycoses Study Group; AIDS, acquired immunodeficiency syndrome; GM, galactomannan; BAL, bronchoalveolar lavages; CT scan, computerized tomography scan; IPA, invasive pulmonary aspergillosis.