Pulmonary TB and chronic pulmonary aspergillosis: clinical differences and similarities

Baluku, Joseph Baruch; Nuwagira, Edwin; Bongomin, Felix; Denning, David W.

doi:10.5588/ijtld.21.0034

Cited by 27 publications

(30 citation statements)

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“…This is consistent with previously published cases from the rest of the world [6,9,55]. PTB and CPA share several important features-both being progressive parenchymal diseases with overlapping risk factors, symptoms and radiological findings that often lead to misdiagnosis of both disease [5,8,56]. In fact, in most low-and middle-income countries where the index of clinical suspicion and diagnostic capabilities are still low, CPA is managed as smear negative-TB.…”

Section: Discussionsupporting

confidence: 91%

Mapping of Chronic Pulmonary Aspergillosis in Africa

Olum

Osaigbovo

Baluku

et al. 2021

JoF

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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.

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Section: Discussionsupporting

confidence: 91%

Mapping of Chronic Pulmonary Aspergillosis in Africa

Olum

Osaigbovo

Baluku

et al. 2021

JoF

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“… 4 There are many similarities between PTB and CPA in terms of risk factors, clinical presentation, and radiological features, making the two diseases clinically indistinguishable. 5 This may result in misdiagnosis of CPA as PTB, or vice versa. As PTB is more common and largely recognised globally, the index of suspicion for PTB is likely higher compared to CPA, particularly in settings with a high PTB burden.…”

Section: Introductionmentioning

confidence: 99%

“…Being mostly diagnosed as a post-PTB complication, CPA may be misdiagnosed as relapsed PTB infection and managed as such. 5 CPA may also be occasionally misdiagnosed as primary TB infection. 5 Some studies have reported CPA misdiagnosed as acid-fast bacilli (AFB) smear-negative or GeneXpert Mycobacterium tuberculosis (MTB)-negative PTB and resulting in worsening symptoms and anti-TB treatment failure.…”

Section: Introductionmentioning

confidence: 99%

Chronic pulmonary aspergillosis is common among patients with presumed tuberculosis relapse in Ghana

et al. 2022

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Chronic pulmonary aspergillosis (CPA) may mimic pulmonary tuberculosis (PTB). The two diseases are clinically indistinguishable and may result in CPA misdiagnosed as PTB or vice versa. Although, PTB is largely recognised as a differential diagnosis of CPA and often ruled out prior to CPA diagnosis, the converse is uncommon. The aim of this study was to determine the proportion of CPA cases among patients being assessed for PTB. A cross-sectional survey was conducted among consecutive patients referred for GeneXpert Mycobacterium tuberculosis (MTB) test for the diagnosis of PTB at the Korle-Bu Teaching Hospital, Accra, Ghana. Patients’ demographics, clinical and socioeconomic details were obtained using a structured questionnaire. Blood was collected for Aspergillus and HIV serology, and sputum samples obtained for Aspergillus culture. Chest radiograph was obtained, and computed tomography (CT) scan was also done for patients with positive Aspergillus serology or cavitation. CPA was defined using an algorithm developed by the Global Action for Fungal Infections (GAFFI) international expert panel. One hundred and fifty-four patients were included in the analysis, of whom 134 (87%) did not have a prior PTB diagnosis. There were 41 (26.6%) GeneXpert positive cases. CPA prevalence was 9.7% overall, but 50% in patients with a prior history of PTB and 3.7% in those without previous PTB. Although CPA is rarely considered as a differential diagnosis of PTB in Ghana, our findings show that CPA may affect half of patients being assessed for PTB relapse. Efforts to diagnose CPA should be prioritised in this patient group.

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“…Another example is the fungus A. fumigatus , described as responsible for the extracellular synthesis of extremely small (0.68 nm) cube-shaped AgNPs [ 15 ]. Nonetheless, this genus is also responsible for a parenchymal lung disease called aspergillosis [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Biological Synthesis of Low Cytotoxicity Silver Nanoparticles (AgNPs) by the Fungus Chaetomium thermophilum—Sustainable Nanotechnology

Alves

Paschoal

Klimeck

et al. 2022

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Fungal biotechnology research has rapidly increased as a result of the growing awareness of sustainable development and the pressing need to explore eco-friendly options. In the nanotechnology field, silver nanoparticles (AgNPs) are currently being studied for application in cancer therapy, tumour detection, drug delivery, and elsewhere. Therefore, synthesising nanoparticles (NPs) with low toxicity has become essential in the biomedical area. The fungus Chaetomium thermophilum (C. thermophilum) was here investigated—to the best of our knowledge, for the first time—for application in the production of AgNPs. Transmission electronic microscopy (TEM) images demonstrated a spherical AgNP shape, with an average size of 8.93 nm. Energy-dispersive X-ray spectrometry (EDX) confirmed the presence of elemental silver. A neutral red uptake (NRU) test evaluated the cytotoxicity of the AgNPs at different inhibitory concentrations (ICs). A half-maximal concentration (IC50 = 119.69 µg/mL) was used to predict a half-maximal lethal dose (LD50 = 624.31 mg/kg), indicating a Global Harmonized System of Classification and Labelling of Chemicals (GHS) acute toxicity estimate (ATE) classification category of 4. The fungus extract showed a non-toxic profile at the IC tested. Additionally, the interaction between the AgNPs and the Balb/c 3T3 NIH cells at an ultrastructural level resulted in preserved cells structures at non-toxic concentrations (IC20 = 91.77 µg/mL), demonstrating their potential as sustainable substitutes for physical and chemically made AgNPs. Nonetheless, at the IC50, the cytoplasm of the cells was damaged and mitochondrial morphological alteration was evident. This fact highlights the fact that dose-dependent phenomena are involved, as well as emphasising the importance of investigating NPs’ effects on mitochondria, as disruption to this organelle can impact health.

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Pulmonary TB and chronic pulmonary aspergillosis: clinical differences and similarities

Cited by 27 publications

References 0 publications

Mapping of Chronic Pulmonary Aspergillosis in Africa

Mapping of Chronic Pulmonary Aspergillosis in Africa

Chronic pulmonary aspergillosis is common among patients with presumed tuberculosis relapse in Ghana

Biological Synthesis of Low Cytotoxicity Silver Nanoparticles (AgNPs) by the Fungus Chaetomium thermophilum—Sustainable Nanotechnology

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