Prevalence and predictors of Aspergillus seropositivity and chronic pulmonary aspergillosis in an urban tertiary hospital in Sierra Leone: A cross-sectional study

Abstract

Background In the World Health Organization Global Tuberculosis (TB) Report 2022, 37% of pulmonary TB patients were clinically diagnosed and thus many people were treated for TB without evidence of the disease. Probably the most common TB misdiagnosis is chronic pulmonary aspergillosis (CPA). In this study, we aimed to assess the prevalence and predictors of Aspergillus seropositivity and CPA in patients with chronic respiratory symptoms in an urban tertiary hospital in Sierra Leone. Methodology/principal findings We used a cross-sectional study design to recruit adults (≥18 years) from the Chest Clinic of Connaught Hospital, Freetown between November 2021 and July 2022. Aspergillus antibody was detected using LDBio Aspergillus IgM/IgG. Logistic regression was performed to assess the independent predictors of Aspergillus seropositivity and CPA. Of the 197 patients with chronic respiratory symptoms, 147 (74.6%) were male. Mean age was 47.1 ± 16.4 years. More than half (104, 52.8%) had been diagnosed with TB in the past, while 53 (26.9%) were on TB treatment at the time of recruitment. Fifty-two (26.4%) patients were HIV positive, 41 (20.8%) were seropositive for Aspergillus and 23 (11.6%) had CPA, 2 (3.8%) with current TB and 18 (17.3%) with past TB. Common radiologic abnormalities reported were localized fibrotic changes 62 (31.5%), consolidation 54 (27.4%), infiltrates 46 (23.4%), hilar adenopathy 40 (20.3%) and pleural effusion 35 (17.85) and thickening 23 (11.7%). Common symptoms were weight loss 144 (73.1%), cough 135 (68.5%), fever 117 (59.4%) and dyspnea 90 (45.7%). Current or past TB infection {aOR 3.52, 95% CI (1.46, 8.97); p = 0.005} was an independent predictor of Aspergillus seropositivity and CPA. Conclusions/significance We report a high prevalence of Aspergillus antibody seropositivity and CPA, underscoring the need to integrate the prevention and management of pulmonary fungal infections with TB services and asthma care in order to reduce unnecessary morbidity and mortality.

Chronic Pulmonary Aspergillosis as a Considerable Complication in Post-Tuberculosis Lung Disease

“…79 In a recent cross-sectional study in an urban tertiary hospital in Sierra Leone, current or past TB infection (odds ratio: 3.52) was an independent predictor of Aspergillus seropositivity and CPA. 80 Risk factors for CPA in patients with active TB are age > 40 years, smoking, diabetes, low body mass index, male sex, steroid use, and cavitary disease. 6 The frequency of hemoptysis in PTLD patients with CPA was reported to be high ranging from 20 up to 68%.…”

Prevalence of chronic pulmonary aspergillosis along the continuum of pulmonary tuberculosis care: A protocol for a living systematic review and meta-analysis

“…Of these, approximately 1.2 million cases are thought to be due to previously treated PTB. Recent estimates from Africa has shown that PTB accounts for over 60% of underlying disease among over 1,200 published cases of CPA across the continent [14][15][16]. A recent study in India estimated an annual incidence of 363,601 cases of CPA associated with PTB and 42,766 deaths, accounting for 11% of total PTB deaths.…”

“…Our current understanding of the spectrum of CPA in a population of PTB patients has broadened, with observational studies showing that CPA occurs in about 8% of patients being treated as smear-negative or PTB relapse [7], 4 to 20% in early PTB or end of PTB treatment and in patients with persistent symptoms despite optimal anti-tuberculous treatment [8,10,14,18], and 1 to 54% post-PTB treatment [6,8,9,11,13,14,19].…”