Received by the Editorial Office: 19 мая 2026 г.
Accepted for publication: 25 июня 2026 г.
Published online: 30 июня 2026 г.
UDC: 616.24-002.5:612.215.4:616.9-07-085
DOI: 10.26212/2227-1937.2026.64.33.011
MIXED RESPIRATORY TRACT INFECTION IN A FEMALE PATIENT WITH PULMONARY TUBERCULOSIS: DIAGNOSIS, TREATMENT, AND OUTCOMES: A CASE REPORT
Shaimerdenova A.K. ¹, Mutaikhan Zh.², Nurtazina Zh.B. ²,
Skak K.², Matisheva G.I. ¹, Akisheva A.V. ¹
¹ Regional Center of Phthisiopulmonology, Karaganda, Kazakhstan
² Karaganda Medical University, Karaganda, Kazakhstan
Introduction. In patients with pulmonary tuberculosis, secondary bacterial infections and persistent fungal airway colonization may complicate the clinical course, reduce the effectiveness of empirical therapy, and make clinical and radiological interpretation more difficult. In the context of prolonged antibacterial exposure, the combination of Pseudomonas aeruginosa extensively drug-resistant (XDR) phenotype and Candida albicans requires dynamic microbiological monitoring and cautious clinical interpretation.
Objective. To demonstrate the diagnostic approach, treatment strategy, and clinical and radiological outcome in a female patient with infiltrative pulmonary tuberculosis complicated by secondary Pseudomonas aeruginosa extensively drug-resistant (XDR) phenotype infection and persistent Candida albicans airway colonization.
Materials and Methods. A clinical case of a 47-year-old female patient hospitalized from 27 February 2025 to 29 May 2025 is presented. A retrospective analysis of medical records, clinical course, radiological findings, GeneXpert MTB/RIF and Bioneer results, repeated sputum cultures, quantitative microbial growth, and antimicrobial susceptibility data was performed. Written informed consent was obtained from the patient for publication of this anonymized case report.
Results. The disease initially presented as severe bilateral polysegmental pneumonia without response to empirical antibacterial therapy. GeneXpert MTB/RIF confirmed Mycobacterium tuberculosis without rifampicin resistance, and Bioneer confirmed preserved susceptibility to isoniazid and rifampicin. Repeated sputum cultures revealed persistent growth of Candida albicans at 10⁶ and 10⁵ CFU/mL and Pseudomonas aeruginosa at 10⁷ CFU/mL with an XDR phenotype. Treatment adjustment based on microbiological monitoring was followed by positive clinical and radiological dynamics and completion of antituberculosis therapy.
Discussion. This case shows that a single negative sputum culture does not exclude subsequent detection of clinically relevant secondary flora. Persistent isolation of Candida albicans requires cautious interpretation and should not automatically be considered evidence of invasive infection without clinical and laboratory confirmation. The scientific value of this observation lies in the documented combination of drug-susceptible pulmonary tuberculosis, Pseudomonas aeruginosa XDR phenotype, and repeated Candida albicans airway colonization with sequential microbiological and radiological monitoring.
Conclusion. Repeated microbiological sputum testing in patients with pulmonary tuberculosis and insufficient clinical improvement has important diagnostic and therapeutic value. This case supports a personalized approach to the management of tuberculosis complicated by secondary airway flora; however, as a single case report, it does not allow causal conclusions or statistical generalization.
Keywords: pulmonary tuberculosis; Pseudomonas aeruginosa; Candida albicans; airway colonization; XDR phenotype; antimicrobial resistance; case report; phthisiology.
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