Comparison Of Pulmonary Fungal Infections And Pulmonary Bacterial Infections In Patients Without Mechanical Ventilation

Objective: Pulmonary fungal infections often occur during the treatment of pulmonary bacterial infections. The clinicians always feel puzzled to distinguish them from pulmonary bacterial infections. It will be of great clinical significance to know about the clinical characteristics of pulmonary fungal infections, the study of which will be helpful for us to make a rapid diagnosis and treatment of such disease. The clinical features of pulmonary fungal infections are not typical and the prognoses are not very serious especially in patients without mechanical ventilation. As a result, clinicians often neglect them. The patients have to suffer much more pain and economic burden due to the misdiagnosis and the delayed treatment. Therefore, We compared several clinical characteristics of pulmonary fungal infections with pulmonary bacterial infections in patients without mechanical ventilation by a case-control study design. Our research is to find out the clinical features of pulmonary fungal infections in these patients, which could distinguish them from the bacterial ones and help us to make a correct diagnosis of such infections.Method: A case-control study was used. 30 patients with pulmonary fungal infections or pulmonary bacterial infections were selected into the case group or the control group respectively if they met the strict selection criteria. All the patients we studied were the inpatients of the department of respiratory medicine in our hospital from Nov. 2001 to Dec. 2002. The matched standard was also taken into consideration. The clinical manifestation, laboratory examination results, X-ray check results and several risk factors were involved in the comparison of the two groups.Results: There were several significant differences between the case group and the control group. 15(50%) patients with pulmonary fungal infections had the difficulties to spit sputum out, which were more than the patients (13%) of those with pulmonary bacterial infections (p<0.05). The percentage of neutrophils, lymphocytes, middle nuclear cell of the case group was 0.824±0.081,0.115±0.069,0.063±0.033 respectively as compared with 0.895±0.051,0.067±0.042,0.039±0.026 of the control group. The two groups had significant differences (p<0.05). A/G(albumin/globulin)was 1.3±0.4 in the case group, which was lower than that in the control group 1.6±0.5(p<0.05). The risk factors of pulmonary fungal infections included long-term or mass scale therapy with corticosteroid, having never accepted the anti-fungi cures and a negative result of germ culture in lower respiratory secretion (p<0.05). Candida, accounting for 87.6%, was the main pathogen that caused the pulmonary fungal infections. Candida albican was the most common pathogen, which made up 56.7% of pulmonary fungal infections and 87.6% of Candida. Fungus resistant to Fluconazole was also found in a certain proportion(30%).Conclusion: we had found several differences of the clinical characteristics between pulmonary fungal and bacterial infections. These differences may be the distinctly clinical features. It will be helpful to pay attention to these clinical features to make distinguish diagnosis from pulmonary bacterial infections. That could be useful for clinicians to find out pulmonary fungal infections promptly. Candida albican was the main pathogen that caused the pulmonary fungal infections. Fungus resistant to Fluconazole was also found in a certain proportion. It suggested that it's necessary to inspect the pathogens and test the antibiotics sensitivity in vitro.