Shifting sands: Unveiling the changes in respiratory comorbidities and fungal pathogens in Saudi Arabia.

Objectives: To investigate epidemiological changes in respiratory fungal infections (RFI), including fungal isolation and colonization, at one of the main centers in Medina. The incidence of RFI is rising due to an increase in the number of immunocompromised individuals, a higher prevalence of respiratory viral infections, and an aging population.

Methods: A retrospective cross-sectional study was conducted by extracting data of patients with fungal-positive respiratory cultures from King Fahad Hospital (KFH), Al Madinah Al Munawwarah from 2013 to 2023.

Results: A total of 352 episodes of fungal-positive cultures were identified in 79 patients, reflecting a 12-fold increase in RFI prevalence. The most frequent fungus was Candida albicans 43% (n=150), followed by C. tropicalis at 34% (n=119), C. glabrata at 7% (n=25), C. parapsilosis at 5% (n=18), C. dubliniensis at 3.4% (n=12), and Aspergillus fumigatus at 3.4% (n=12). Bronchoalveolar lavage was performed 52 times, with 19 cultures growing C. albicans and 8 cultures positive for A. fumigatus. None of the 58 lung biopsy samples grew mold. Only one patient had 2 C. glabrata isolates resistant to voriconazole and fluconazole. The most prevalent comorbidities were respiratory diseases (30%) and lower limb injuries and diabetes (16%).

Conclusion: Candida albicans was the leading cause of RFI. Continuous monitoring, improved diagnostics, and targeted interventions are crucial to address existing challenges and emerging threats. The growing recognition of fungal infections necessitates increased research and education for healthcare professionals.