Mapping of Chronic Pulmonary Aspergillosis in Africa

Abstract

Africa has a high burden of tuberculosis, which is the most important risk factor for chronic pulmonary aspergillosis (CPA). Our goal was to systematically evaluate the burden of CPA in Africa and map it by country. We conducted an extensive literature search for publications on CPA in Africa using the online databases. We reviewed a total of 41 studies published between 1976 and 2021, including a total of 1247 CPA cases from 14 African countries. Most of the cases came from Morocco (n = 764, 62.3%), followed by South Africa (n = 122, 9.9%) and Senegal (n = 99, 8.1%). Seventeen (41.5%) studies were retrospective, 12 (29.3%) were case reports, 5 case series (12.2%), 5 prospective cohorts, and 2 cross-sectional studies. The majority of the cases (67.1%, n = 645) were diagnosed in men, with a median age of 41 years (interquartile range: 36–45). Active/previously treated pulmonary tuberculosis (n = 764, 61.3%), human immunodeficiency virus infection (n = 29, 2.3%), diabetes mellitus (n = 19, 1.5%), and chronic obstructive pulmonary disease (n = 10, 0.8%) were the common co-morbidities. Haemoptysis was the most frequent presenting symptom, reported in up to 717 (57%) cases. Smoking (n = 69, 5.5%), recurrent lung infections (n = 41, 3%) and bronchorrhea (n = 33, 3%) were noted. This study confirms that CPA is common in Africa, with pulmonary tuberculosis being the most important risk factor.

Outcomes of surgery for different types of chronic pulmonary aspergillosis: results from a single-center, retrospective cohort study

“…Chronic pulmonary aspergillosis is a pulmonary infection caused by caused by Aspergillus species [ 1 ]. Recent reports have shown an increased incidence of CPA in recent years [ 2 – 4 ]. The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the European Respiratory Society (ERS) reached an agreement on the rationale and clinical guidelines for diagnosis and management for CPA in 2015 [ 5 ].…”

Chronic pulmonary aspergillosis in patients with active pulmonary tuberculosis with persisting symptoms in Uganda

“…A recent study evaluating over 1200 cases of CPA in Africa identified current active or previous PTB as an underlying structural lung disease in over 70% of the cases 16 . A few epidemiological studies from across Africa and other countries in Asia have reported varying CPA prevalence based on the population of TB patients studied.…”

Chronic cavitary pulmonary aspergillosis in an immunocompetent child

“…Rare cases of CPA misdiagnosed as pulmonary tuberculosis and pneumonia have been reported in immunocompetent and immunodeficient children with chronic granulomatous disease and hyper-IgE syndrome [ [10] , [11] , [12] ]. Untreated CPA in patients with respiratory disease can be life-threatening, leading to significant deterioration in their quality of life with a case fatality of 75–80% in 5 years [ 13 ]. In Africa, the availability and access to essential diagnostics and medications for most fungal diseases remain a challenge [ 13 ].…”

“…Untreated CPA in patients with respiratory disease can be life-threatening, leading to significant deterioration in their quality of life with a case fatality of 75–80% in 5 years [ 13 ]. In Africa, the availability and access to essential diagnostics and medications for most fungal diseases remain a challenge [ 13 ]. The majority of CPA in Nigeria are in the adult population with sparse data on the paediatric population.…”