Shafiq Anwer, M Hayat Zafar, Hayat M Awan.
A clinical study of pulmonary mycosis at Multan.
Pak J Med Res Jan ;41(1):9-15.

Beside tuberculosis, awareness about chest diseases is increasing and more non-tuberculosis lung infections are being recognized. Pulmonary mycosis is not uncommon. A clinical study of pulmonary mycosis was undertaken in Nishtar Hospital Multan, Pakistan. In our study the prevalence of pulmonary mycosis was 8.2 percent among the patients suffering from respiratory, diseases, whereas this prevalence was higher in males (10.3%) as compared to females (5%). The peak prevalence was observed in the age group of 21-30 years (22%), however, 82 percent patients of mycosis lie in 3rd to 7th decades. No significant relation of occupation to pulmonary mycosis was detected in the present study. The disease was higher in urban population as compared to rural inhabitants and it was more in people with low income and having poor living conditions. Candidiasis and Aspergillosis were found predominant in lower income group. All the three pulmonary mycosis (detected in this study) have higher relationship with pulmonary tuberculosis, and it was observed that Aspergillosis was relatively more common in lung abscess and cavitary lesion. Majority of patients had the symptoms of cough, sputum, fever, dyspnoea, chest pain and haemoptysis. The clinical examination showed anemia, enlarged liver, pleural effusion, clubbing, oedema feet, lymph node enlargements and cyanosis in these patients. Sputum culture for fungus was helpful in diagnosing the cases and repeated growth was significant. Out of 35 patients of Candida Albicans, 17 were living, while 18 had died due to associated diseases and the cause of death in 15 cases was advanced pulmonary tuberculosis, lung abscess in 2 and pneumonia in 1 case. Out of 11 cases of Aspergillosis, 9 were living and 2 had died due to associated disease and the cause of death in 1 case was lung abscess and 1 was pneumonia, while in mucormycosis 2 were living, 1 died due to pulmonary tuberculosis and 1 patient was not traceable. Steroids were added in acute stage along with antifungal drugs for 6 weeks, The patients were symptom free after 6 weeks, the sign disappeared but the lesion of associated disease persisted. Fungus ball in the cavity persisted even after the treatment. Surgery was advised but not done due to non-cooperation of patients. Follow up was made and it was observed that 21 cases expired, 28 were known to live at the end of study, while fate of 1 case was not known.

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