Pulmonary Aspergillosis in Naïve Non-neutropenic Lung Cancer Patients

Pulmonary aspergillosis is the most common mould infection of the lungs. Patients with chronic lung disease or mild immunodeficiency are at risk. Lung cancer represents an oncological challenge. Limited data are available about aspergillosis in newly diagnosed non-neutropenic lung cancer patients.Objectives: The aim of this work was to evaluate naïve lung cancer patients for the presence of as-pergillosis, identify fungal isolates, and determine antifungal susceptibility. The inhibitory effect of secondary metabolites of fungal isolates on the human fibroblast cell line was also assessed.Methods: Cross-section cohort study recruited newly diagnosed non-neutropenic lung cancer patients. Bronchoalveolar lavage was performed in 69 patients. Isolation of fungi on Sabouraud dextrose agar, morphological and molecular identification of fungal isolates, antifungal susceptibility testing, and cell viability assay with cell culture and MTT assay were done.Results: Aspergillus isolates were detected in 33 BAL samples out of the 69 patients (47.8%). The commonest isolate was A. niger. There was no significant correlation between total fungal count and age of patients. The antifungal Micafungin had a broad-spectrum and potent fungistatic activity against all fungal species, with A. niger being the most sensitive. MTT assay was performed to evaluate the cytotoxic effect of both A. niger and A. fumigatus on normal lung cells (WI-38) and revealed that toxicity was concentration-dependent and A. niger had significantly lower IC 50, indicating more toxicity.Conclusion: In the context of the diagnosis of lung cancer, maintaining vigilance is crucial to diagnose fungal infection as aspergillosis. Initiation of proper management can help improve patient outcomes.