Chronic pulmonary aspergillosis as a cause of smear negative TB and or anti-TB treatment failure in Nigerians

Rita Oladele, NK Irurhe, P. Foden, Alani S. Akanmu , T Gbaja-Biamila, A Nwosu, H A Ekundayo, Folasade T Ogunsola, Malcolm Richardson, David Denning

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Abstract

Objective: We evaluated CPA as an alternative diagnosis of smear negative TB and treatment failure in TB patients in Nigeria.

Methods: We conducted a cross-sectional multicenter survey in HIV positive and negative adult patients at the end of their TB treatment in clinics in Lagos and Ilorin states. All were assessed by clinical examination, chest X-ray and Aspergillus IgG serology and some for sputum fungal culture. CPA was defined as a positive Aspergillus fumigatus IgG titre with compatible chest X-ray or a positive sputum culture of Aspergillus with a visible fungal ball on the chest X-ray with symptoms with underlying lung disease.

Findings: 208 patients were recruited between June 2014 and May 2015. 153 (73.6%) were HIV positive. Mean age was 39.8 years, 124 (59.6%) were female and 39 (18.8%) were unable to work. Median CD4 count (range) was 169.5 cells/ml (4-593) in the HIV infected patients with positive Aspergillus IgG. 109 (52.4%) had documented TB and 140 (67.3%) had productive cough and 50 had haemoptysis. The prevalence of CPA was 8.7%; 10 (6.5%) with HIV infection and 8 (14.5%) HIV negative patients (Fisher’s exact p=0.092).

Conclusion: CPA is a neglected disease in Nigeria, most matching the WHO diagnostic criteria for ‘smear-negative’ tuberculosis.
Original languageEnglish
Pages (from-to)1056-1061
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Volume21
Issue number9
DOIs
Publication statusPublished - 1 Sept 2017

Keywords

  • Aspergillosis
  • tuberculosis
  • HIV
  • chronic pulmonary aspergillosis
  • aspergillus serology

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