Tuberculosis Coinfections

Tuberculosis coinfects with other bacteria, fungi and viruses.

Tuberculosis (TB) has been a major human menace since ancient times. Worldwide in 2018, an estimated 10 million humans were infected with TB and about 1.5 million died from TB infections ¹. Tuberculosis lung infections often occur together or coinfect with other bacteria, fungi, and viruses (especially HIV). Such coinfections usually increase the severity and mortality rate of TB infections.  Fungi which can coinfect with tuberculosis infections include Aspergillus, Candida, and Coccidioidomyces.   Research of fungi and TB coinfections are described briefly below.

Aspergillum and Tuberculosis Coinfections

Aspergillus and Tuberculosis coinfections are quite common.  A meta-analysis of 17 published studies involving 2,286 TB patients- including 352 with Aspergillus coninfection estimated the occurrence of Aspergillus/ TB coninfection of 15.4% (95% Confidence Interval 11.4-20.5%) ². A 2020 French study found Aspergillus lung coinfection in 50 out of 140 patients, a 35.7% Coinfection rate ³. Aspergillus/ TB coinfections have increased mortality rates as compared to TB infections alone.  A Japanese study of 329 TB patients reported that coinfection with Aspergillus (40 coinfectins in all) were associated with a more than 4 fold higher mortality rate as compared to TB infections alone (HR4.728, 95% CI of 2.033- 11.00, p<0.001) ⁴.

Candida and Tuberculosis coinfections

Candida and Tuberculosis coinfections are also quite common.  A meta-analysis of 18 published studies in Africa and Asia reported that 446 out of 1,736 TB patients also had coinfection with Candida- a coinfection rate of 25.7% (95% CI of 23.7-27.9) ¹.

Coccidioidomyces Tuberculosis coinfections

A case study was presented of 9 Texas patients infected with both Coccioidomyces (Valley Fever) and TB, with 2 patients dying ⁵. The authors believe that combined Coccioidomyces and TB is probably common in endemic areas of southwestern United States and northwestern Mexico.

Related Articles:

Is Tuberculosis a Fungal Disease?

Coronavirus & Fungi Coinfections Part 1

Coronavirus & Fungi Coinfections Part 2

Research and References:

1. Hadadi-Fishani M, Shakerimoghaddam A, Khaledi A. Candida coinfection among patients with pulmonary tuberculosis in Asia and Africa; A systematic review and meta-analysis of cross-sectional studies. Microb Pathog. 2020;139:103898.

2. Hosseini M, Shakerimoghaddam A, Ghazalibina M, Khaledi A. Aspergillus coinfection among patients with pulmonary tuberculosis in Asia and Africa countries; A systematic review and meta-analysis of cross-sectional studies. Microb Pathog. 2020:104018.

3. Delliere S, Angebault C, Fihman V, et al. Concomitant Presence of Aspergillus Species and Mycobacterium Species in the Respiratory Tract of Patients: Underestimated Co-occurrence? Frontiers in microbiology. 2019;10:2980.

4. Furuuchi K, Ito A, Hashimoto T, Kumagai S, Ishida T. Clinical significance of Aspergillus species isolated from respiratory specimens in patients with Mycobacterium avium complex lung disease. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2018;37(1):91-98.

5. Cadena J, Hartzler A, Hsue G, Longfield RN. Coccidioidomycosis and tuberculosis coinfection at a tuberculosis hospital: clinical features and literature review. Medicine (Baltimore). 2009;88(1):66-76.