Martha Namusobya1, Felix Bongomin2, John Mukisa3, William Kane Olwit4, Charles Batte1, Claudine Mukashyaka5, Emmanuel Mande5, Richard Kwizera5, David W Denning6, Joshua Rhein7, Shailendra Prasad7, Christine Sekaggya-Wiltshire5. 1. School of Medicine, College of Health Sciences, Makerere Lung Institute, Makerere University, Kampala, Uganda. 2. Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda. 3. Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda. 4. Department of Radiology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. 5. College of Health Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda. 6. Manchester Fungal Infection Group, University of Manchester, Manchester, UK. 7. Centre for Global Health and Social Responsibility, University of Minnesota, Minneapolis, Minnesota, USA.
Abstract
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.
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.
Authors: Khaled Al-Shair; Eavan G Muldoon; Julie Morris; Graham T Atherton; Chris Kosmidis; David W Denning Journal: Respir Med Date: 2016-04-02 Impact factor: 3.415
Authors: Felix Bongomin; Nelesh P Govender; Arunaloke Chakrabarti; Florence Robert-Gangneux; David R Boulware; Afia Zafar; Rita O Oladele; Malcolm D Richardson; Jean-Pierre Gangneux; Ana Alastruey-Izquierdo; Joel Bazira; Tom H Boyles; Jahit Sarcarlal; Mathieu Nacher; Taminori Obayashi; William Worodria; Alessandro C Pasqualotto; David B Meya; Ben Cheng; Charlotte Sriruttan; Conrad Muzoora; Andrew Kambugu; Juan Luis Rodriguez Tudela; Alexander Jordan; Tom M Chiller; David W Denning Journal: Eur J Clin Microbiol Infect Dis Date: 2019-09 Impact factor: 3.267