TY - JOUR
T1 - Chronic pulmonary aspergillosis in patients with active pulmonary tuberculosis with persisting symptoms in Uganda
AU - Namusobya, Martha
AU - Bongomin, Felix
AU - Mukisa, John
AU - Olwit, William Kane
AU - Batte, Charles
AU - Mukashyaka, Claudine
AU - Mande, Emmanuel
AU - Kwizera, Richard
AU - Denning, David W.
AU - Rhein, Joshua
AU - Prasad, Shailendra
AU - Sekaggya-Wiltshire, Christine
N1 - Publisher Copyright:
© 2022 Wiley-VCH GmbH.
PY - 2022/6
Y1 - 2022/6
N2 - Background: The occurrence of chronic pulmonary aspergillosis (CPA) among drug sensitive pulmonary tuberculosis (PTB) patients on optimal therapy with persistent symptoms was investigated. Methods: We consecutively enrolled participants with PTB with persistent pulmonary symptoms after 2 months of anti-TB treatment at Mulago Hospital, Kampala, Uganda, between July 2020 and June 2021. CPA was defined as a positive Aspergillus-specific IgG/IgM immunochromatographic test (ICT), a cavity with or without a fungal ball on chest X-ray (CXR), and compatible symptoms >3 months. Results: We enrolled 162 participants (median age 30 years; IQR: 25–40), 97 (59.9%) were male, 48 (29.6%) were HIV-infected and 15 (9.3%) had prior PTB. Thirty-eight (23.4%) sputum samples grew A. niger and 13 (8.0%) A. fumigatus species complexes. Six (3.7%) participants had intracavitary fungal balls and 52 (32.1%) had cavities. Overall, 32 (19.8%) participants had CPA. CPA was associated with prior PTB (adjusted odds ratio [aOR]: 6.61, 95% CI: 1.85–23.9, p =.004), and far advanced CXR changes (aOR: 4.26, 95% CI: 1.72–10.52, p =.002). The Aspergillus IgG/IgM ICT was positive in 10 (31.3%) participants with CPA. Conclusions: Chronic pulmonary aspergillosis may cause persistent respiratory symptoms in up to one-fifth of patients after intensive treatment for PTB. The Aspergillus IgG/IgM ICT positivity rate was very low and may not be used alone for the diagnosis of CPA in Uganda.
AB - Background: The occurrence of chronic pulmonary aspergillosis (CPA) among drug sensitive pulmonary tuberculosis (PTB) patients on optimal therapy with persistent symptoms was investigated. Methods: We consecutively enrolled participants with PTB with persistent pulmonary symptoms after 2 months of anti-TB treatment at Mulago Hospital, Kampala, Uganda, between July 2020 and June 2021. CPA was defined as a positive Aspergillus-specific IgG/IgM immunochromatographic test (ICT), a cavity with or without a fungal ball on chest X-ray (CXR), and compatible symptoms >3 months. Results: We enrolled 162 participants (median age 30 years; IQR: 25–40), 97 (59.9%) were male, 48 (29.6%) were HIV-infected and 15 (9.3%) had prior PTB. Thirty-eight (23.4%) sputum samples grew A. niger and 13 (8.0%) A. fumigatus species complexes. Six (3.7%) participants had intracavitary fungal balls and 52 (32.1%) had cavities. Overall, 32 (19.8%) participants had CPA. CPA was associated with prior PTB (adjusted odds ratio [aOR]: 6.61, 95% CI: 1.85–23.9, p =.004), and far advanced CXR changes (aOR: 4.26, 95% CI: 1.72–10.52, p =.002). The Aspergillus IgG/IgM ICT was positive in 10 (31.3%) participants with CPA. Conclusions: Chronic pulmonary aspergillosis may cause persistent respiratory symptoms in up to one-fifth of patients after intensive treatment for PTB. The Aspergillus IgG/IgM ICT positivity rate was very low and may not be used alone for the diagnosis of CPA in Uganda.
KW - Uganda
KW - chronic pulmonary aspergillosis
KW - persistent symptoms
KW - pulmonary tuberculosis
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U2 - 10.1111/myc.13444
DO - 10.1111/myc.13444
M3 - Article
C2 - 35419885
AN - SCOPUS:85128761915
SN - 0933-7407
VL - 65
SP - 625
EP - 634
JO - Mycoses
JF - Mycoses
IS - 6
ER -
