Patients from 55 chest clinics in Great Britain with post tuberculous cavities were studied for evidence of colonization with Aspergillus species. The selected patients had a persistent cavity at least 2.5 cm. in diameter and tubercle bacilli had not been found in their sputum for at least a year.
The first survey in 1964-65 showed that of 544 patients, 25% had precipitins to aspergillus in the serum. Radiographic evidence of an aspergilloma was present in 11% and of a probable aspergilloma in 3 % of the total, whilst 10 % had precipitins without such radiographic appearances.
The patients were resurveyed three years later, using similar techniques. The mortality in the series was high (18 %) but it was no higher in those with precipitins or aspergillomas than in those without.
Patients with aspergillomas were found to have only two disadvantages. They were more likely to have chronic cough and to have haemoptysis, which was sometimes severe. Patients with precipitins alone in the first survey were at no great disadvantage, except that they were twice as likely to develop aspergilloma as those without precipitins. In nearly a quarter the precipitin test became negative and in many instances it appeared to be an indication of transient infection with aspergillus.
15 % of the patients without precipitins in the first survey had developed them by the second survey and about half of these had also acquired aspergillomas. The development of an aspergilloma in these was associated with thickening of the cavity wall and increased pleural thickening. Aspergillomas appeared as frequently in those whose tuberculosis had been inactive for a long time as in those in whom it had become inactive more recently.
A few aspergillomas disappeared spontaneously or during a pyogenic infection in the cavity. These were fewer than the number of new colonizations, so that at the end of the second survey 34 % of the survivors had precipitins. 17 % had aspergillomas and 3 % had probable aspergillomas with precipitins, and 14 7; had precipitins alone.
In the patients where the aspergilloma was resected, the precipitin test result became weaker, but not negative.