Prevalence and Pattern of Isolated Fungi from Bronchoalveolar Lavage in Patients with Lung Cancer: A Cross-sectional Study

1. Resident Doctor, Institute of Respiratory Diseases, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. 2. Professor, Institute of Respiratory Diseases, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. 3. Associate Professor, Department of Preventive and Social Medicine, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India. 4. Junior Specialist, Institute of Respiratory Diseases, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.

Abstract

Introduction: Fungal infections have emerged as a significant healthcare challenge worldwide, particularly among terminally ill, debilitated, and immunocompromised populations. In patients with lung malignancy, fungal colonisation of the bronchial tree can predispose them to serious pulmonary infections and may adversely influence prognosis, especially in those undergoing chemotherapy. Understanding the prevalence and pattern of fungal colonisation in these patients is therefore clinically relevant, as it may directly affect outcomes and survival.

Aim: To determine the prevalence and pattern of fungi isolated from Bronchoalveolar Lavage (BAL) samples in patients with lung cancer.

Materials and Methods: This cross-sectional study included 101 patients with clinical and radiological suspicion of lung cancer who underwent Fiberoptic Bronchoscopy (FOB) with biopsy at Sawai Man Singh Medical College, Jaipur, Rajasthan, India. BAL samples were collected and processed for fungal culture. Demographic, clinical, and radiological findings, as well as histological types of lung cancer, were recorded. Data were analysed using appropriate statistical tests: the Chi-square or Fisher’s exact test for categorical variables, the independent samples t-test for normally distributed continuous variables, and the Mann-Whitney test for non normally distributed data. A p-value≤0.05 was considered statistically significant.

Results: Fungal growth was detected in 34 of 101 patients (33.66%). The mean age in the fungal-positive group was 62.2±10.1 years. Candida albicans was isolated in nine cases (8.91%), Aspergillus niger in seven cases (6.9%), Candida tropicalis in six cases (5.9%), and other fungi in 12 cases (11.9%). Colonisation was more frequent in males (82.4%, n=28) and smokers (85.3%, n=29). Half of the patients with Chronic Obstructive Pulmonary Disease (COPD) demonstrated fungal infection compared to 35.8% of non COPD cases, although this difference was not statistically significant (p-value=0.16). Among species, Candida albicans was associated with higher dyspnoea scores (2.11±1.17). Lung mass (73.5%, n=25) was the most common radiological finding, followed by pleural effusion (41.2%, n=14). Squamous cell carcinoma (52.9%, n=18) was the predominant histological type among fungal-positive cases, followed by adenocarcinoma (20.6%, n=7).

Conclusion: Fungal colonisation is relatively common in patients with lung cancer, particularly among males, smokers, and those with COPD. Its presence may adversely influence survival and response to chemotherapy, underscoring the need for early detection and targeted management.

Chronic obstructive pulmonary disease, Fungal infections, Smokers