Onset of chronic pulmonary aspergillosis (CPA) may occur during active pulmonary tuberculosis

Iain D Page1, William Worodria2, Alfred Andama2, Irene Ayakaka2, Richard Kwizera1,2, Lucian Davis3, Laurence Huang3 Malcolm Richardson1, David W Denning1

Abstract: 

Chronic pulmonary aspergillosis (CPA) is known to complicate successfully treated pulmonary TB.

Our recent cross-sectional survey in Uganda diagnosed CPA in 8.2% of 400 patients who had been cured of TB in the previous 7 years1.

This supports a recent estimate that the global prevalence of CPA secondary to TB is 1.3 million cases2.

CPA has a 5-year mortality of 50-85%.

CPA has been shown to be effectively treated with cheap, generic, oral itraconazole in resource-poor settings in an RCT.

CPA can be cured with surgery in selected cases.

CPA presents with chronic cough, haemoptysis, weight loss and raised levels of Aspergillus-specific IgG.

The most common radiological feature is progressive cavitation, with aspergilloma present in only 32% cases.

The clinical and radiological presentation of CPA is therefore normally almost identical to that of TB itself.

ESCMID guidelines suggest that CPA should only be diagnosed when other conditions with a similar presentation, including active tuberculosis, have been excluded.

There are, however several case reports documenting co-infection with active pulmonary tuberculosis and Aspergillus, proven by the unambiguous radiological evidence of aspergilloma formation.

The natural history of CPA is not well described.

It is not known whether onset of CPA occurs during or after active TB.

We postulate that the onset of CPA occurs during the time of active pulmonary tuberculosis.

The Siemens Aspergillus-specific IgG assay has recently been shown to have a sensitivity of 96% and specificity of 98% for the diagnosis of CPA3.

2016

Poster: 

abstract No: 

P100

Full conference title: 

7th Advances Against Aspergillosis