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.
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 language | English |
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Pages (from-to) | 1-13 |
Number of pages | 13 |
Journal | European Respiratory Journal |
Volume | 53 |
Issue number | 3 |
Early online date | 31 Jan 2019 |
DOIs | |
Publication status | Published - 18 Mar 2019 |