Epidemiology of pulmonary fungal infections in Tanta University Chest Hospital: risk factors and exploration of novel plant-based antifungal agents

Abstract Introduction Fungal pulmonary infections pose significant diagnostic and therapeutic challenges, particularly in high-risk populations. This study investigates the epidemiology of mycotic pulmonary infections in ICU patients and evaluates the antifungal potential of wild plants from Southeast Egypt. Aims (1) Characterize the demographic and microbiological profile of pulmonary fungal infections and (2) assess the antimicrobial activity of indigenous plant extracts against prevalent fungal pathogens. Methods A prospective observational study was conducted in the ICU and bronchoscopy unit of Tanta University Chest Hospital (July 2022–June 2023). Clinical data and fungal isolates were collected from 60 patients with mycotic pulmonary infections. Concurrently, ethanolic extracts of seven wild plants (e.g., Indigofera articulata , Zilla spinosa ) from Halayeb and Shalateen were screened for antifungal activity via MIC assays and transmission electron microscopy (TEM). Results Infections peaked in summer (40%), with higher incidence among smokers (53.3%), farmers (26.7%), males (66.6%), and patients > 40 years (83.3%). Rural residents accounted for 60% of cases. Aspergillus niger (33.3%) was the predominant isolate, followed by Penicillium spp. and Candida albicans (16.7% each). Indigofera articulata extract exhibited the strongest activity (MIC: 12.5 mg/ml against Cladosporium sp.), with TEM revealing cell wall rupture, protein agglutination, and cytoplasmic leakage. Conclusions Mycotic pulmonary infections disproportionately affect older, rural, and occupational risk groups in Egypt. Indigenous plant extracts, particularly I. articulata , showed promising antifungal effects, warranting further exploration for therapeutic development.