Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist

Bongomin, Felix; Asio, Lucy Grace; Baluku, Joseph Baruch; Kwizera, Richard; Denning, David W.

doi:10.3390/jof6020075

Cited by 42 publications

(47 citation statements)

References 111 publications

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“…It is important to note that most patients with CPA have multiple underlying lung conditions [12]. Other important non-TB underlying conditions include chronic obstructive pulmonary disease (COPD), fibrocystic sarcoidosis, pneumothorax, and other [12,21].…”

Section: Are These Lives Saved Forever?mentioning

confidence: 99%

Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

Bongomin

2020

PLoS Pathog

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How common is CPA after treated PTB? CPA is a progressive respiratory syndrome that largely occur in immunocompetent or subtly immunocompromised individuals with underlying structural lung diseases, most commonly treated TB [11]. Residual cavities remain in between 20% to 40% of lungs of patients following treatment for PTB [12,13]. Cavitation and ectatic lesions in PTBLD allows saprophytic colonisation and growth of Aspergillus species following inhalation of infectious spores from the environment. This leads to expansion of the existing or creation of new cavities with associated parenchymal and pleural damage [11]. A complex mixture of Aspergillus hyphae, tissue debris, inflammatory cells, and mucin known as a fungal ball (aspergilloma) may form in these cavities [11]. The significance of treated PTB in the pathogenesis of CPA was established by a large cohort study across over 50 clinics in Great Britain in the mid-to late 1960s [14]. In this landmark study, 544 patients who had a persistent cavity of at least 2.5 cm in diameter and negative M. tuberculosis bacilli in their sputum for at least a year were studied. About 25% of the patients had positive Aspergillus precipitins (i.e., precipitating immunoglobulin M [IgM] and immunoglobulin G

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Section: Are These Lives Saved Forever?mentioning

confidence: 99%

Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

Bongomin

2020

PLoS Pathog

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“…Multiple studies have attempted to approximate the global impact of aspergilloses and to discern any appreciable changes in incidence over time. Surveys have recently estimated the current burden of aspergilloses worldwide, approximating 4.8 million cases of ABPA, 3 million cases of chronic pulmonary aspergillosis (CPA) and between 250, 000 and 400, 000 cases of IA annually (Brown et al ., 2012; Bongomin et al ., 2017; CDC, 2019; Bongomin et al ., 2020). IA occurs in up to 14% of heart transplant recipients, up to 7% of bone marrow transplant recipients, and up to 10% of haematological malignancy and lung transplant patients (Eggimann et al ., 2006).…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of triazole resistance in Aspergillus fumigatus

Nywening

Rybak

Rogers

et al. 2020

Environmental Microbiology

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The ubiquitous fungal pathogen Aspergillus fumigatus is the primary cause of opportunistic mould infections in humans. Aspergilli disseminate via asexual conidia passively travelling through air currents to germinate within a broad range of environs, wherever suitable nutrients are found. Though the average human inhales hundreds of conidia daily, A. fumigatus invasive infections primarily affect the immunocompromised. At-risk individuals can develop often fatal invasive disease for which therapeutic options are limited. Regrettably, the global insurgence of isolates resistant to the triazoles, the frontline antifungal class used in medicine and agriculture to control A. fumigatus, is complicating the treatment of patients. Triazole antifungal resistance in A. fumigatus has become recognized as a global, yet poorly comprehended, problem. Due to a multitude of factors, the magnitude of resistant infections and their contribution to treatment outcomes are likely underestimated. Current studies suggest that human drug-resistant infections can be either environmentally acquired or de novo host selected during patient therapy. While much concerning development of resistance is yet unknown, recent investigations have revealed assorted underlying mechanisms enabling triazole resistance within individual clinical and environmental isolates. This review will provide an overview of triazole resistance as it is currently understood, as well as highlight some of the prominent biological mechanisms associated with clinical and environmental resistance to triazoles in A. fumigatus.

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“…Detection of Aspergillus IgG in serum is the core of laboratory assessments for CPA [ 9 , 10 , 11 ]. Antibodies can be detected using various methods such as an enzyme-linked immunosorbent assay (ELISA), immunoprecipitation, complement fixation, haemagglutination, immunoblot and lateral flow assay [ 9 , 12 ]. Lateral flow assay (LFA) has been used in recent years to simplify the detection of Aspergillus IgG with fast results and minimal laboratory equipment [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Chronic Pulmonary Aspergillosis in Post Tuberculosis Patients in Indonesia and the Role of LDBio Aspergillus ICT as Part of the Diagnosis Scheme

Rozaliyani

Rosianawati

Handayani

et al. 2020

JoF

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Chronic pulmonary aspergillosis (CPA) is a common sequela of pulmonary tuberculosis (TB). The diagnosis of CPA is difficult and often misdiagnosed as smear-negative TB in endemic settings. Aspergillus IgG detection is the cornerstone of CPA diagnosis. There are a lack of studies on the prevalence of CPA in GeneXpert/smear-negative TB patients in Indonesia, despite a high number of TB cases. This study aims to determine the CPA rate in HIV-negative, GeneXpert-negative patients presenting with symptoms following completion of TB therapy and to evaluate the performance of LDBio Aspergillus immunochromatographic technology (ICT) lateral flow assay in the diagnosis of CPA. CPA was diagnosed on the basis of symptoms for ≥3 months, characteristic chest imaging and positive Aspergillus culture. Twenty (22%) out of 90 patients met the criteria for CPA. The LDBio test was positive in 16 (80%) CPA patients and in 21 (30%) non-CPA patients (p < 0.001) with 80% sensitivity and 70% specificity. Logistic regression revealed a positive LDBio Aspergillus ICT result, smoking history and diabetes to be important predictors of CPA diagnosis. Although CPA is an unrecognised disease in Indonesia, this study suggests that more than one in five GeneXpert negative patients with persistent symptoms following completion of TB therapy may have CPA.

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Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist

Cited by 42 publications

References 111 publications

Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

Mechanisms of triazole resistance in Aspergillus fumigatus

Chronic Pulmonary Aspergillosis in Post Tuberculosis Patients in Indonesia and the Role of LDBio Aspergillus ICT as Part of the Diagnosis Scheme

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