Spectrum of Bacterial and Fungal Co-infections in Sputum Smear-Positive Pulmonary Tuberculosis: A Cross-Sectional Study from a Tertiary Care Centre in Northern India

Spectrum of Bacterial and Fungal Co-infections in Sputum Smear-Positive Pulmonary Tuberculosis: A Cross-Sectional Study from a Tertiary Care Centre in Northern India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Spectrum of Bacterial and Fungal Co-infections in Sputum Smear-Positive Pulmonary Tuberculosis: A Cross-Sectional Study from a Tertiary Care Centre in Northern India Sakshi Bisht, Rajesh Gupta, Parul Punia, Anupama Gupta, Neha Saharan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8807980/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pulmonary tuberculosis remains a significant global health burden, particularly in developing countries. Bacterial and fungal co-infections complicate clinical outcomes and increase mortality; however, comprehensive data from northern India are limited. This study aimed to analyze the spectrum of bacterial and fungal co-infections in sputum smear-positive pulmonary tuberculosis patients. Methods This cross-sectional study enrolled 100 consecutive sputum smear-positive pulmonary tuberculosis patients aged > 18 years at a tertiary care center in Haryana, India. Sputum samples underwent Gram staining, bacterial culture on blood agar and MacConkey agar, potassium hydroxide mount, and fungal culture on Sabouraud dextrose agar. Demographic, clinical, radiological, and laboratory parameters were analyzed using chi-square tests, Mann-Whitney U tests, and multivariate logistic regression. Results The mean age was 45.4 ± 16.4 years with male predominance (67%). Bacterial co-infection was documented in 50% of patients, with Pseudomonas aeruginosa (19%), Klebsiella pneumoniae (10%), and Staphylococcus aureus (9%) predominating. Fungal co-infection occurred in 18%, predominantly Candida species (15%). Gram-negative organisms constituted 69% of bacterial isolates. Elevated total leukocyte count independently predicted bacterial co-infection (p = 0.008). Diabetes mellitus demonstrated strong association with fungal co-infection (OR = 3.14, p = 0.055), while hemoptysis was significantly associated with fungal co-infection (p < 0.001). Conclusions Bacterial and fungal co-infections are highly prevalent in sputum smear-positive pulmonary tuberculosis patients. Routine microbiological screening, particularly in patients with leukocytosis, diabetes, or hemoptysis, may facilitate early detection and appropriate management, potentially improving treatment outcomes. Pulmonary tuberculosis bacterial co-infection fungal co-infection sputum smear-positive Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8807980","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590387881,"identity":"b4132af3-5eb5-4a2a-a882-8f64d198a0c7","order_by":0,"name":"Sakshi Bisht","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIie3PsWrDMBCA4QuGdNEDBFLQK1wpaDL2g3SxEChTwWOGDC4tzujVkGcodCodXQSeRL0K4sFe0rXFS4YOlTMW7LpbIfrH4z5OAnC5/mVz8AALAgsAjNa+nczuionEg7jRsifJBAJ2x5LP9kGdZqOEbkvRxXF9SXfZ6xNPquBxq+yVjX8zRFDLcpnjgWCtPOQve/GsuSWlvE2GCKxSj6AiuBBz5HovWGHJLFGDhGbv911PaC4ujjx9E6xqxwkYWSx7AkYA8rQImPnlCpqDtMT+xQjESIuIGXslGvkLzeR1R77qkOa8uTqug5BVq7b52PjDD/sZP21GU9f7wr8su1wu13n0DeMsaEfk7IQvAAAAAElFTkSuQmCC","orcid":"","institution":"Pt. 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Bacterial and fungal co-infections complicate clinical outcomes and increase mortality; however, comprehensive data from northern India are limited. This study aimed to analyze the spectrum of bacterial and fungal co-infections in sputum smear-positive pulmonary tuberculosis patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study enrolled 100 consecutive sputum smear-positive pulmonary tuberculosis patients aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years at a tertiary care center in Haryana, India. Sputum samples underwent Gram staining, bacterial culture on blood agar and MacConkey agar, potassium hydroxide mount, and fungal culture on Sabouraud dextrose agar. Demographic, clinical, radiological, and laboratory parameters were analyzed using chi-square tests, Mann-Whitney U tests, and multivariate logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age was 45.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4 years with male predominance (67%). Bacterial co-infection was documented in 50% of patients, with Pseudomonas aeruginosa (19%), Klebsiella pneumoniae (10%), and Staphylococcus aureus (9%) predominating. Fungal co-infection occurred in 18%, predominantly Candida species (15%). Gram-negative organisms constituted 69% of bacterial isolates. Elevated total leukocyte count independently predicted bacterial co-infection (p\u0026thinsp;=\u0026thinsp;0.008). Diabetes mellitus demonstrated strong association with fungal co-infection (OR\u0026thinsp;=\u0026thinsp;3.14, p\u0026thinsp;=\u0026thinsp;0.055), while hemoptysis was significantly associated with fungal co-infection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBacterial and fungal co-infections are highly prevalent in sputum smear-positive pulmonary tuberculosis patients. Routine microbiological screening, particularly in patients with leukocytosis, diabetes, or hemoptysis, may facilitate early detection and appropriate management, potentially improving treatment outcomes.\u003c/p\u003e","manuscriptTitle":"Spectrum of Bacterial and Fungal Co-infections in Sputum Smear-Positive Pulmonary Tuberculosis: A Cross-Sectional Study from a Tertiary Care Centre in Northern India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-13 20:17:56","doi":"10.21203/rs.3.rs-8807980/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f4c61c02-aff7-4de3-ac0d-a10efcaf7971","owner":[],"postedDate":"February 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-24T19:23:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-13 20:17:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8807980","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8807980","identity":"rs-8807980","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}