Pulmonary aspergillosis in HIV/AIDS: An increasing burden to patients in tropical regions attending a rural hospital in Enugu Ezike, Southeastern Nigeria.

Pulmonary aspergillosis (PA) is a pulmonary disease of mycotic origin, usually caused by A. fumigatus and other species such as A. niger, A. flavus and A. terreus. This study was carried out to isolate and identify Aspergillus species from HIV/AIDS patients with lower respiratory symptoms and to ascertain the extent of damage that can be caused by the recovered species using an animal model. Sputum samples (n = 132) were collected from HIV/AIDS patients attending a general hospital in Southeastern Nigeria. The samples were processed using standard microbiological methods to obtain pure cultures which were further identified and characterized. For the in-vivo study, 36 Swiss albino mice were divided into 9 groups of 4 each, with groups A and I serving as positive and negative controls respectively. The animals were inoculated with different species of Aspergillus at concentration of 5×106 for groups A, B, C and D; and a combined concentration of 5×106 and 5×105 in varying ratios of 10:1:1and 1:1 for the groups E to H. The overall results showed high prevalence of A. fumigatus and a statistically significant (p < 0.05) relationship between Aspergillus infection and viral load. A. fumigates was the most prevalent species recovered (62.96 %), while A. niger had the lowest prevalence of 17.28 %. Also, those aged 36-55 years had the highest prevalence rate of 57.60 %. The rate of Aspergillus infection was higher in males (53.7 %) compared to females (50.8 %). Damages to the major organs were more severe in animals with co-infections. There was vacuolar degeneration and enlargement of the hepatocytes which tended to occlude the adjacent hepatic sinusoids in all the test mice groups. In the spleen, there was evidence of extramedullary haematopoiesis shown by increased number of megakaryocytes in groups A, C, E, G and H, while in groups B, D and F, there was decreased population of lymphoid cells in the lymphoid sheath of periarteriolar of the white pulp. Pulmonary aspergillosis affected mostly HIV individuals with increased viral load beyond suppression limit of 50 copies/ml. Multiple or co-infection is possible and could contribute to negative outcome of the infection treatment among the study population.