Association of Presence of Aspergillus Antibodies with Hemoptysis in Patients with Old Tuberculosis or Bronchiectasis but No Radiologically Visible Mycetoma

Abstract

Old tuberculosis and bronchiectasis are the two most important causes of chronic structural changes of lungs in our locality. In the absence of radiologically visible mycetoma, the cause of hemoptysis in these two groups of patients is largely unknown. A 17-month prospective study was carried out to compare the prevalence of Aspergillus fumigatus and Aspergillus flavus antibodies in hemoptysis patients with old tuberculosis or bronchiectasis but no radiologically visible mycetoma (cases, n ‫؍‬ 38), hemoptysis patients with other diagnosis (control group 1, n ‫؍‬ 29), and patients with old tuberculosis or bronchiectasis but no hemoptysis (control group 2, n ‫؍‬ 47) by a recently developed sensitive and specific A. fumigatus and A. flavus antibody assay. There were a significantly larger number of patients with antibody against A. fumigatus or A. flavus among the cases than among the patients in control groups 1 and 2 (P < 0.05 in both comparisons). Molds were not recovered from any of the patients. Among the 10 cases with Aspergillus antibody, eight and two had antibody against A. flavus and A. fumigatus, respectively. We conclude that there was an association between the presence of Aspergillus antibodies and hemoptysis in patients with old tuberculosis or bronchiectasis, suggesting that these patients probably had occult infections caused by the corresponding fungi. Development of serological tests against other Aspergillus species as well as other causes of mycetoma will probably increase the detection of occult mold infections in patients with existing parenchymal lung diseases, and treatment of fungal microinvasion may help to alleviate hemoptysis in these patients with bronchiectasis or old tuberculosis who have Aspergillus antibodies.

Post-primary pulmonary TB haemoptysis – When there is more than meets the eye

“…Pulmonary aspergillosis may manifest as cavities containing fungal balls referred to as mycetoma's or as chronic cavitatory or fibrosing aspergillosis [ 10 ]. Occurring in 7–11% of patients after previous PTB, the presence of both a mycetoma on radiological imaging (with CT demonstrating greater diagnostic accuracy than a standard chest x-ray [ 11 ]) as well as serum aspergillus antibodies leads to an increase incidence of clinically evident haemoptysis [ 12 ]. Erosion of adjacent vasculature and intra-cavitatory bleeding serve as the basis for haemoptysis in these patients [ 6 ].…”

A 10-year study reveals clinical and laboratory evidence for the ‘semi-invasive’ properties of chronic pulmonary aspergillosis

“…Patients with CPA were the most likely among the three groups to receive antifungal treatment (CPA, 100.0% IPA, 80.4% PA, 48.4%), and the median treatment duration was also the longest (CPA, 176.5 days; IPA, 42.5 days; PA, 106.0 days), corroborating the slowly progressive course of CPA, which might improve with long-term antifungal treatment ( Table 1 ). 18 In contrast, nearly 20% of the patients with the more invasive IPA died before the diagnosis was suspected or shortly after treatment was started, and the less-invasive PA usually did not warrant treatment. In those who survived in the CPA group, a much shorter hospitalization duration for rehabilitation was usually required when compared with those who survived in the IPA group.…”

Genomic and experimental evidence for a potential sexual cycle in the pathogenic thermal dimorphic fungus Penicillium marneffei

“…Subsequently, we showed that the mitochondrial genome of P. marneffei most closely related to that of A. nidulans, with the set of protein coding genes in the P. marneffei mitochondrial genome exactly the same as that in the A. nidulans mitochondrial genome, and except for the atp9 gene, the gene order of the protein genes is also the same as that in the A. nidulans mitochondrial genome [14]. Furthermore, their close relationships are also exemplified by the presence of unique antigenic proteins of the ''antigenic mannoprotein superfamily'' in P. marneffei and Aspergillus species [30][31][32][33][34][35][36][37][38][39], which have never been shown to be present in fungal species of other genera. In this study, all the genes in the putative sexual cycle of P. marneffei are found to be most closely related to their orthologues in Aspergillus species.…”