Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation

Iain Page, Rosemary Byanyima, Sharath Hosmane, Nathan Onyachi, Cyprian Opira, Malcolm Richardson, Richard Sawyer, Anna Sharman, David Denning

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Abstract

Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis, with high 5-year mortality. We measured CPA prevalence in this group.

398 Ugandans with treated pulmonary tuberculosis underwent clinical assessment, chest X-ray and Aspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including CT thorax in 73 with suspected CPA. CPA was diagnosed in patients without active tuberculosis who had raised Aspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.

Author-defined CPA was present in 14 (4.9%) resurvey patients (95% confidence interval 2.8% - 7.9%). CPA was significantly more common in those with chest X-ray cavitation (26% vs. 0.8%, P<0.001), but possibly less frequent in HIV co-infected patients (3% vs. 6.7%, p=0.177). The annual rate of new CPA development between surveys was 6.5% in those with chest X-ray cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening on chest X-ray had 100% negative predictive value for CPA. The combination of raised Aspergillus-specific IgG, chronic cough or haemoptysis and chest X-ray cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis.

CPA commonly complicates treated pulmonary tuberculosis with residual chest X-ray cavitation. Chest X-ray alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.
Original languageEnglish
Pages (from-to)1-13
Number of pages13
JournalEuropean Respiratory Journal
Volume53
Issue number3
Early online date31 Jan 2019
DOIs
Publication statusPublished - 18 Mar 2019

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