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

Research output: Contribution to journalArticlepeer-review

15 Downloads (Pure)

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
JournalEuropean Respiratory Journal
Early online date31 Jan 2019
DOIs
Publication statusPublished - 2019

Fingerprint

Dive into the research topics of 'Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation'. Together they form a unique fingerprint.

Cite this