Prevalence of chronic pulmonary aspergillosis in patients with tuberculosis from Iran

Abstract

In patients with preexisting lung disease, especially a cavity, Aspergillus can infect the surface of the cavity, causing chronic cavitary pulmonary aspergillosis (CCPA), and may form an aspergilloma, collectively called chronic pulmonary aspergillosis (CPA). In the present study, we assessed tuberculosis (TB) patients for CPA based on culture and serological methods. During a period of 1 year (from March 2013 to March 2014), we studied 124 patients with TB (94 with current TB and 30 with previous TB) at Masih Daneshvari Hospital in Tehran, Iran. Sputum specimens were analyzed by direct microscopic examination (DME) and fungal culture. The clinical and radiological features of all patients were recorded, to categorize the patients into CCPA and aspergilloma. All patients were screened for serum-specific IgG against A. fumigatus, by enzyme-linked immunosorbent assay (ELISA). Out of 124 patients with TB (66 male, age range: 10-91 years), 48 patients (38.7 %) exhibited residual cavities. Eighteen (14.5 %) patients had cavities with pleural thickening. A round-shaped mass lesion was detected in six patients (6.8 %). DME was positive in ten patients for septate fungal hyphae. A. fumigatus was grown from 14 samples. Fifty-five (44.3 %) cases were positive for serum-specific IgG against A. fumigatus. Of 124 patients with TB, 3 (2.4 %) met criteria for aspergilloma and 14 (11.3 %) for CCPA. CPA is a common clinical presentation in individuals with healed TB in Iran, as reported by previous studies from other countries.

Quantitative Analysis of Single-Nucleotide Polymorphism for Rapid Detection of TR 34 /L98H- and TR 46 /Y121F/T289A-Positive Aspergillus fumigatus Isolates Obtained from Patients in Iran from 2010 to 2014

“…Of note, five out of six azole-resistant isolates were recovered from CPA patients. The significant predilection to CPA is in agreement with the findings of recent studies in Iran which demonstrated that CPA is the most common clinical presentation of aspergillosis in individuals with healed tuberculosis (35). Importantly, patients with CPA require long-term maintenance antifungal therapy to improve symptoms and prevent the recurrence of infection (36,37).…”

Characterization of patients with chronic pulmonary aspergillosis according to the new ESCMID/ERS/ECMM and IDSA guidelines

“…Symptoms include weight‐loss, severe fatigue, shortness of breath, and haemoptysis leading to a 5‐year case fatality rate of 20‐50% even when treated . Major risk factors are underling pulmonary diseases, especially those leading to a structural damage of the lung such as tuberculosis, non‐tuberculous mycobacteria (NTM) pulmonary diseases, chronic obstructive pulmonary disease (COPD) and other chronic pulmonary diseases . Despite common understanding CPA is not a disease of the severely immunocompromised host such as invasive aspergillosis, although the subacute invasive pulmonary aspergillosis (SAIA; formally called chronic necrotizing pulmonary aspergillosis), which is a sub‐entity of CPA, is usually seen in patients with a mild immunosuppression.…”

“…[6][7][8][9] Major risk factors are underling pulmonary diseases, especially those leading to a structural damage of the lung such as tuberculosis, non-tuberculous mycobacteria (NTM) pulmonary diseases, chronic obstructive pulmonary disease (COPD) and other chronic pulmonary diseases. [10][11][12][13] Despite common understanding CPA is not a disease of the severely immunocompromised host such as invasive aspergillosis, although the subacute invasive pulmonary aspergillosis (SAIA; formally called chronic necrotizing pulmonary aspergillosis), which is a sub-entity of CPA, is usually seen in patients with a mild immunosuppression. All other forms of CPA including single aspergilloma, aspergillus nodule(s), chronic cavitary pulmonary aspergillosis (CCPA), and chronic fibrosing pulmonary aspergillosis (CFPA) are exclusively seen in patients with underlying respiratory disorders without severe immunosuppression.…”

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

“…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. In a recent study from Iran, the incidence rate of aspergilloma with CCPA and single aspergilloma were reported as 11.0% and 2.4%, respectively 12 . However, there are also some case report of aspergilloma in TB patients from Iran 13–15 …”

“…In several studies 9,12,16,18 , Aspergillus species especially A. fumigatus have been reported as the main aetiologic agent of culture‐proven cases of fungus balls. Therefore, the diagnostic approaches were often designed based on the diagnosis of aspergilloma.…”