Volume 14, Issue 2 (2-2026)                   JoMMID 2026, 14(2): 168-177 | Back to browse issues page

Ethics code: 003/01/2024


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Nkem Awujo C, Gaina E, Brown S. Isolation of Cryptococcus Species from Sputum of Patients with Presumptive Pulmonary Tuberculosis Attending a Referral Hospital in Cross River State, Nigeria. JoMMID 2026; 14 (2) :168-177
URL: http://jommid.pasteur.ac.ir/article-1-769-en.html
Department of Microbiology, Faculty of Biosciences, Federal University Wukari, P.M.B. 1020, Wukari, Taraba State, Nigeria
Abstract:   (12 Views)
Introduction: The differential diagnosis of pulmonary tuberculosis (TB) and fungal infections is important in influencing treatment strategies and enhancing therapeutic success. Therefore, this study aimed to investigate the prevalence of Cryptococcus species among presumptive tuberculosis patients in a referral hospital in Nigeria. Methods: This cross-sectional, hospital-based study was carried out between October 2024 and January 2025. A total of 174 sputum samples were tested for the presence of Mycobacterium tuberculosis using Ziehl-Neelsen staining and the molecular GeneXpert MTB/RIF assay; Cryptococcus species were isolated by culture on Sabouraud Dextrose Agar (SDA) and presumptively identified as encapsulated yeasts using India ink staining. Results: None of the samples (0%) obtained from presumptive tuberculosis patients were positive for M. tuberculosis, highlighting the importance of investigating other pathogens, such as Cryptococcus species, in patients presenting with TB-like symptoms. Cryptococcus species were isolated from 21 of 174 patients, giving an overall prevalence of 12.1%. A significant gender disparity was observed, with females showing a much higher prevalence (35.2%) compared with males (1.7%). Age was not significantly associated with infection status, although individuals aged 50–59 years had the highest age-specific prevalence, with 4 out of 20 patients (20.0%) testing positive. Statistical analysis confirmed the significant gender difference (χ² = 39.426, P < 0.001), while the association with age was not statistically significant (Fisher–Freeman–Halton exact test statistic = 7.681, P = 0.199). No Cryptococcus isolates were recovered from participants aged 1–9 years, 40–49 years, and ≥ 60 years. Conclusion: The moderate prevalence of Cryptococcus species observed in this study suggests their potential as a lower respiratory tract pathogen in presumptive tuberculosis patients. The results of this study show the need to integrate fungal screening into routine diagnostic protocols for tuberculosis, especially where fungi such as Cryptococcus species are often neglected.
Full-Text [PDF 1066 kb]   (4 Downloads)    
Type of Study: Original article | Subject: Infectious diseases and public health
Received: 2025/08/16 | Accepted: 2026/02/21 | Published: 2026/09/7

References
1. World Health Organization. WHO fungal priority pathogens list to guide research, development and public health action [Internet]. Geneva: World Health Organization; 2022 [cited 2025 May 23]. Available from: https://www.who.int/publications/i/item/9789240060241
2. Bongomin F, Gago S, Oladele RO, Denning DW. Global and multi-national prevalence of fungal diseases-estimate precision. J Fungi (Basel). 2017; 3 (4): 57. [DOI:10.3390/jof3040057] [PMID] [PMCID]
3. Lionakis MS, Drummond RA, Hohl TM. Immune responses to human fungal pathogens and therapeutic prospects. Nat Rev Immunol. 2023; 23 (7): 433-52. [DOI:10.1038/s41577-022-00826-w] [PMID] [PMCID]
4. Lass-Flörl C, Kanj SS, Govender NP, Thompson GR 3rd, Ostrosky-Zeichner L. Invasive candidiasis. Nat Rev Dis Primers. 2024; 10 (1): 20. [DOI:10.1038/s41572-024-00503-3] [PMID]
5. Machado M, Fortún J, Muñoz P. Invasive aspergillosis: a comprehensive review. Med Clin (Barc). 2024; 163 (4): 189-98. [DOI:10.1016/j.medcli.2024.01.045] [PMID]
6. Ekeng BE, Oladele RO, Emanghe UE, Ochang EA, Mirabeau TY. Prevalence of histoplasmosis and molecular characterization of Histoplasma species in patients with presumptive pulmonary tuberculosis in Calabar, Nigeria. Open Forum Infect Dis. 2022; 9 (8): ofac368. [DOI:10.1093/ofid/ofac368] [PMID] [PMCID]
7. Rajasingham R, Govender NP, Jordan A, Loyse A, Shroufi A, Denning DW, et al. The global burden of HIV-associated cryptococcal infection in adults in 2020: a modelling analysis. Lancet Infect Dis. 2022; 22 (12): 1748-55. [DOI:10.1016/S1473-3099(22)00499-6] [PMID]
8. Weissferdt A. Infectious lung disease. In: Diagnostic thoracic pathology. Cham: Springer International Publishing; 2020. pp. 3-71. [DOI:10.1007/978-3-030-36438-0_1] [PMCID]
9. Amiri Fahliyani S, Rastegari AA, Yadav N, Yadav AN. Human fungal pathogens: diversity, genomics, and prevention. In: Yadav AN, editor. Recent trends in mycological research: volume 1, agricultural and medical perspective. Cham: Springer International Publishing; 2021. pp. 371-394. [DOI:10.1007/978-3-030-60659-6_16]
10. Oladele R, Otu AA, Olubamwo O, Makanjuola OB, Ochang EA, Ejembi J, et al. Evaluation of knowledge and awareness of invasive fungal infections amongst resident doctors in Nigeria. Pan Afr Med J. 2020; 36: 297. [DOI:10.11604/pamj.2020.36.297.23279] [PMID] [PMCID]
11. Muni S, Rajpal K, Kumar R, Kumari R, Sinha R, Kumar S, et al. Identification of fungal isolates in patients with pulmonary tuberculosis treated at a tertiary care hospital. Cureus. 2023; 15 (4): e37664. [DOI:10.7759/cureus.37664]
12. Prasad R, Singh A, Sharma S, Patel D, Tiwari S, Chouhan M. Association of clinical and demographic factors with fungal culture in pulmonary tuberculosis patients. Bioinformation. 2026; 22 (1): 452-5. [DOI:10.6026/973206300220452] [PMID] [PMCID]
13. Rebuma T, Parmar RB, Parmar BC, Pal M. Emerging fungal pathogens pose a growing threat to global health. J Adv Microbiol Res. 2024; 5 (2): 1-5.
14. Ekeng BE, Davies AA, Osaigbovo II, Warris A, Oladele RO, Denning DW. Pulmonary and extrapulmonary manifestations of fungal infections misdiagnosed as tuberculosis: the need for prompt diagnosis and management. J Fungi. 2022; 8: 460. [DOI:10.3390/jof8050460] [PMID] [PMCID]
15. Mereškevičienė R, Danila E. The adverse effects of tuberculosis treatment: a comprehensive literature review. Medicina. 2025; 61 (5): 911. [DOI:10.3390/medicina61050911] [PMID] [PMCID]
16. World Health Organization. Global tuberculosis report 2025 [Internet]. Geneva: World Health Organization; 2025 [cited 2025 Nov 20]. Available from: https://www.who.int/publications/i/item/9789240116924
17. Page ID, Chaabna K, Denning DW, Gning SB, Henkle E, Kwizera R, et al. A systematic review of chronic pulmonary aspergillosis among patients treated for pulmonary tuberculosis. Clin Infect Dis. 2025; 80 (1): e1-e12.
18. National Population Commission (NPC), ICF. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria; Rockville, Maryland, USA: NPC, ICF; 2019.
19. Nigerian Meteorological Agency. Cross River State farmer weather guide [Internet]. Abuja: Nigerian Meteorological Agency; 2025 [cited 2025 May 23]. Available from: https://ejsdprogram.hedang.org/cross-river-state-farmer-weather-guide
20. Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991.
21. World Health Organization. WHO operational handbook on tuberculosis. Module 3: diagnosis - rapid diagnostics for tuberculosis detection. 3rd ed. Web Annex C: Technical manual for culture-based drug susceptibility testing of anti-tuberculosis drugs used in the treatment of tuberculosis. Geneva: World Health Organization; 2024. Available from: https://iris.who.int/bitstreams/12e31c08-a742-47e3-97f2-bd4f0dd3b97c/download
22. Cheesbrough M. District laboratory practice in tropical countries. 2nd ed. Vol. 2. Cambridge: Cambridge University Press; 2006. pp. 35, 64-70, 157-158, 179-191.
23. Clinical and Laboratory Standards Institute. Principles and procedures for detection and culture of fungi in clinical specimens. 2nd ed. CLSI guideline M54. Wayne, PA: Clinical and Laboratory Standards Institute; 2021. Available from: https://clsi.org/standards/products/microbiology/documents/m54
24. Baadom V, Amadi LO, Sampson T, Aleruchi O. Molecular characterization and antifungal sensitivity pattern of fungi species isolated from presumptive tuberculosis patients in University of Port Harcourt Teaching Hospital. J Adv Microbiol Res. 2024; 5 (2): 236-41.
25. Njovu IK, Musinguzi B, Mwesigye J, Kassaza K, Turigurwa J, Nuwagira E, et al. Status of pulmonary fungal pathogens among individuals with clinical features of pulmonary tuberculosis at Mbarara University Teaching Hospital in southwestern Uganda. Ther Adv Infect Dis. 2021; 8: 20499361211042477. [DOI:10.1177/20499361211042477] [PMID] [PMCID]
26. Bitew A, Bati S. Profiling of potential pulmonary fungal pathogens and the prevalence of the association between pulmonary tuberculosis and potential fungal pathogens in presumptive tuberculosis patients referred to Saint Peter's Specialized Tuberculosis Referral Hospital, Addis Ababa, Ethiopia. SAGE Open Med. 2021; 9: 20503121211056163. [DOI:10.1177/20503121211056163] [PMID] [PMCID]
27. Cioboata R, Balteanu MA, Osman A, Vlasceanu SG, Zlatian OM, Mitroi DM, et al. Coinfections in tuberculosis in low- and middle-income countries: epidemiology, clinical implications, diagnostic challenges, and management strategies; a narrative review. J Clin Med. 2025; 14 (7): 2154. [DOI:10.3390/jcm14072154] [PMID] [PMCID]
28. Edwards HM, Cogliati M, Kwenda G, Fisher MC. The need for environmental surveillance to understand the ecology, epidemiology and impact of Cryptococcus infection in Africa. FEMS Microbiol Ecol. 2021; 97 (7): fiab093. [DOI:10.1093/femsec/fiab093] [PMID] [PMCID]
29. May RC, Stone NR, Wiesner DL, Bicanic T, Nielsen K. Cryptococcus: from environmental saprophyte to global pathogen. Nat Rev Microbiol. 2016; 14 (2): 106-17. [DOI:10.1038/nrmicro.2015.6] [PMID] [PMCID]
30. Shaw AC, Goldstein DR, Montgomery RR. Age-dependent dysregulation of innate immunity. Nat Rev Immunol. 2013; 13 (12): 875-87. [DOI:10.1038/nri3547] [PMID] [PMCID]
31. Nnadi NE, Carter DA. Climate change and the emergence of fungal pathogens. PLoS Pathog. 2021; 17 (4): e1009503. [DOI:10.1371/journal.ppat.1009503] [PMID]
32. Brown GD, Denning DW, Gow NAR, Levitz SM, Netea MG, White TC. Hidden killers: human fungal infections. Sci Transl Med. 2012; 4 (165): 165rv13. [DOI:10.1126/scitranslmed.3004404] [PMCID]
33. Pfaller MA. Antifungal drug resistance: mechanisms, epidemiology, and consequences for treatment. Am J Med. 2012; 125 (Suppl 1): S3-S13. [DOI:10.1016/j.amjmed.2011.11.001] [PMID]
34. Fisher MC, Hawkins NJ, Sanglard D, Gurr SJ. Worldwide emergence of resistance to antifungal drugs challenges human health and food security. Science. 2018; 360 (6390): 739-42. [DOI:10.1126/science.aap7999] [PMID]
35. Hoenigl M, Sprute R, Egger M, Arastehfar A, Cornely OA, Krause R, et al. The antifungal pipeline: fosmanogepix, ibrexafungerp, olorofim, opelconazole, and rezafungin. Drugs. 2021; 81 (15): 1703-29. [DOI:10.1007/s40265-021-01611-0] [PMID] [PMCID]
36. Perfect JR. The antifungal pipeline: a reality check. Nat Rev Drug Discov. 2017; 16 (9): 603-16. [DOI:10.1038/nrd.2017.46] [PMID] [PMCID]
37. Niazi-Ali S, Atherton GT, Walczak M, Denning DW. Drug-drug interaction database for safe prescribing of systemic antifungal agents. Ther Adv Infect Dis. 2021; 8: 20499361211010605. [DOI:10.1177/20499361211010605] [PMID] [PMCID]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.