Occurrence and Distribution of Aspergillus species among presumptive Tuberculosis Patient in Otukpo Local Government Area of Benue State, Nigeria

Abstract

Aspergilloma is often misdiagnosed as tuberculosis (TB) in developing countries where the prevalence of TB is high, hemoptysis is often equated with TB, and most patients are diagnosed clinically. This study aims to determine the Occurrence and Distribution of Aspergillus species among presumptive tuberculosis patients in Otukpo Local Government Area of Benue State, Nigeria. A total of 461 clients gave their consent and were involved in this research work from four (4) different healthcare facilities in the Otukpo Local government area. The samples were packaged in triple nylon, stored in a cold chain box, and were taken to the general hospital Otukpo laboratory and/or St Charles Hospital Adoka laboratory for analysis. Each Sputum sample was divided into two parts. One part was analyzed for Tuberculosis using PCR (GeneXpert Machine) and the second part was inoculated on Sabouraud Dextrose Agar Medium for identification of Aspergillus species. The Aspergillus species isolated were identified using cultural and comparative pictorial characteristics. Exactly 216 patients had an Aspergillus species prevalence rate of 46.9 %, and 245 patients with 53.1% showed no growths of fungal. The males had a prevalence rate of 113(44.8 %), with the highest rate of 27(10.7 %) in the age group 31 – 40, and females had a prevalence rate of 103(49.3 %), with the highest rate of 18(8.6 %) in the age groups 21 – 30 and 31 – 40 with a significant p-value of 0.015. Co-infections of Aspergillus species/tuberculosis in relation to age range distribution and gender had a total prevalence of 22(4.77 %). The males had a co-infection prevalence rate of 14(3.03%) compared to the females having a co-infection prevalence rate of (1.74%). The age range of 31- 40 had the highest co-infection prevalence rate, followed by the age range of 41-50. There is a significant co-infection of Aspergillus/tuberculosis with a p-value of 0.007. Four species of Aspergillus were identified; Aspergillus niger (38 %) ranked highest, followed by Aspergillus fumigatus (25 %), Aspergillus flavus (24 %), Aspergillus oryzae (6 %), and other fungi isolated were 7%. This research shows a significant positive result of patients with aspergillosis, which is a significant co-morbidity in pulmonary tuberculosis patients in Otukpo Local Government Area of Benue State; this could be misdiagnosed as relapse or treatment failures in the absence of reliable diagnostic and clinical management. The progress of the disease and prolonged treatment with antibiotics or immunosuppressive agents make TB patients susceptible to fungal infection. Patients with persistent clinical symptoms despite TB treatment should be subjected to fungal investigations before re-treatment. Aspergillosis is also one of the nosocomial infections, so patients and healthcare givers should be encouraged to always go for routine fungal infection investigation if few of the symptoms are experienced.