Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation

Abstract

Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography and Aspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raised Aspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%, 95% CI 2.8–7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26% versus 0.8%; p<0.001), but possibly less frequent in HIV co-infected patients (3% versus 6.7%; p=0.177). The annual rate of new CPA development between surveys was 6.5% in those with chest radiography cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening on chest radiography had 100% negative predictive value for CPA. The combination of raised Aspergillus-specific IgG, chronic cough or haemoptysis and chest radiography cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis.CPA commonly complicates treated pulmonary TB with residual chest radiography cavitation. Chest radiography alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.

Galactomannan detection in bronchoalveolar lavage fluids: A diagnostic approach for fungus ball in patients with pulmonary tuberculosis?

“…Therefore, we calculated the prevalence rate of fungus ball as 18.0% in patients with old PTB. Several reports have also shown that CPA or and aspergilloma as a sequel to previous treated TB 1–5,10 . In concordance with Kosmidis and Denning 11 who suggested that the persistence of lung cavities in TB patients with previous successful treatment increase the rate of aspergilloma, in our study all patients with fungus balls had a history of previous treated PTB in a period of 2‐16 years.…”

“…However, Aspergillus species are considered as the most common cause of disease 3 . Scedosporium boydii , Fusarium species and the species related to Mucorales accounted for less than 5% in the occurrence of fungus ball 4,5 …”

Accuracy of serological tests for diagnosis of chronic pulmonary aspergillosis: a systematic review and meta-analysis

“…Several studies have recently been published with serological data using only commercial ELISA tests for CPA diagnosis in an area with a high prevalence of tuberculosis [1, 13, 36].…”

“…Chronic pulmonary aspergillosis (CPA) is a slow and progressive lung disease caused by Aspergillus spp. that develops in preexisting cavities of patients with chronic respiratory diseases, and pulmonary tuberculosis is its main predisposing factor, with a global prevalence estimated at 1.2 million cases [1]. I Its prognosis is poor, with 38-85% mortality in five years [1, 2].…”

“…CPA presents five clinical forms: 1. aspergillus nodule, 2. pulmonary simple aspergilloma, 3. chronic cavitary pulmonary aspergillosis (CCPA), also called complex aspergilloma, 4. chronic fibrosing pulmonary aspergillosis (CFPA), and 5. subacute invasive pulmonary aspergillosis (SAIA) [3]. Aspergilloma is present in only one-third of patients with CPA [1, 4].…”