Incidence of mycobacteria and fungi in clinically suspected urinary tract infection of immunocompromised patients – A tertiary care hospital study

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Background: Urinary tract infections are among the most common infections especially in hospital settings. Most of these infections are caused by bacterial agents. Mycobacterial and fungal agents of urinary tract infections although less frequent in immunocompetent individuals but they are more common and severe in immunocompromised individuals.

Objectives Detection of Mycobacteria and Fungi in urine specimens of clinically suspected urinary tract infection of immunocompromised patients and evaluation of different tests for detection of Mycobacteria and Fungi in urine specimens.

Methods: Study was done in Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, from October 2005 to September 2007. Urine samples of 50 patients with clinical suspicion of Tubercular and Fungal etiology of Urinary tract infection of immunocompromised patients [Diabetes mellitus (14), AIDS (13), Renal transplant recipient (09), Malignancies (07), End stage renal disease/ Chronic renal failure (06), Systemic lupus erythematosus (01)] & 50 apparently immunocompetant patients were taken as diseased control. For Mycobacteria microscopy (Ziehl-Neelsen staining), Culture (Lowenstein Jensen Medium and BACTEC medium), PCR and NAP test were done. For Fungus microscopy (Direct wet mount, Gram's stain), Culture (Sabouraud's Dextrose Agar), Germ tube test, Corn meal agar, Sugar Fermentation & assimilation test were done. Culture was considered as gold standard.

Results: Out of 50 immunocompromised patients, 7(14%) were positive for mycobacteria [MTBC 5(10%), MOTT 2(4%)] and 10(20%) were positive for fungi [C. albicans 4(8%), C. glabrata 4(8%) and C. tropicalis 2(4%)]. Out of 50 apparently immunocompetant patients (diseased control), 4(8%) were positive for mycobacteria [MTBC 3(6%), MOTT 1(2%)] and 3(6%) were positive for fungi [C. albicans 2(4%) and C. tropicalis 1(2%)]. Sensitivity and specificity were 71.42%, 90.69% of Ziehl-Neelsen stain, 88%, 100% of Lowenstein Jensen culture, 57%, 100% of PCR for Mycobacteria, 80%, 100% respectively for wet mount for fungi.

Conclusion: Incidence of mycobacterial/fungal infection in immunocompromised patients is more then to immunocompetent individuals and with immunocompromised conditions, urinary tract infection should be screened for mycobacterial and fungal pathogens.