Author:
BK Ocansey1*, A Adjei2, H Gbadamosi3, C Kosmidis1,4, J Afriyie-Mensah2,5, JO Opintan6, DW Denning1
Author address:
1Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK
2Chest Diseases Unit, Korle-Bu Teaching Hospital, Accra, Ghana
3Radiology Department, Korle-Bu Teaching Hospital, Accra, Ghana
4National Aspergillosis Centre, Wythenshawe Hospital, Manchester, UK
5Department of Medicine and Therapeutics, University of Ghana, Accra, Ghana
6Department of Medical Microbiology, University of Ghana, Accra, Ghana
Full conference title:
10th Advances Against Aspergillosis and Mucormycosis
Date: 2 February 2022
Abstract:
Purpose:
The differential diagnosis of pulmonary tuberculosis (PTB) is broad and includes chronic pulmonary aspergillosis (CPA). CPA is typically considered a sequela of PTB by mimicking infection relapse but it may also be misdiagnosed as a primary PTB infection. The exclusion of CPA as an alternative diagnosis is challenging in resource-constrained settings due to scarce epidemiological data and inadequate access to relevant diagnostics. We conducted a study to detect CPA cases among patients presumed to have PTB using a resource-constrained setting targeted diagnostic algorithm, evaluated the significance of CPA as a differential diagnosis of PTB, and assessed the clinical relevance of Aspergillus IgG & IgM lateral flow device (LFD) in CPA diagnosis.
Methods:
A cross-sectional survey was conducted among patients presenting with PTB-like symptoms and referred for GeneXpert Mycobacterium tuberculosis (MTB) testing for PTB diagnosis at the TB Laboratory, Chest Diseases Unit, Korle-Bu Teaching Hospital, Accra. Participants’ sociodemographic, clinical, and risk factor details were captured using a questionnaire and blood samples collected for Aspergillus IgG & IgM and HIV testing. Sputum was obtained for high volume (1-2ml) fungal culture and a chest radiograph was done for participants or previously taken ones obtained for review. GeneXpert MTB results were retrieved from laboratory records. Chest computed tomography (CT) scan was performed for participants with positive serology or cavitation on chest radiograph. CPA was defined following the case definition of CPA in resource-constrained settings by the Global Action Fund for Fungal Infections (GAFFI) International Expert Panel (2018).
Results:
A total of 183 participants were recruited. Laboratory and complete diagnostic (laboratory and imaging) data were obtained for 163 (89.1%) and 107 (58.5%) participants respectively. For the purpose of defining a case of CPA and determining its true proportionality, only 107 participants with complete diagnostic data were analyzed. Ninety (84.1%) participants were being assessed for new PTB diagnosis and 17 (15.9%) for relapse. MTB positive cases were 34 (31.8%) and 12 (11.2%) participants met the criteria for CPA case definition. Ten (83.3%) CPA cases had previous PTB, representing 58.8% of participants with presumed PTB relapse. Of 12 trace, very low, and low positive MTB cases, four (33.3%) had CPA. Only one (8.3%) CPA case was retropositive. The common symptoms among CPA cases were fatigue (75%, n=9), weight loss (75%, n=9) and haemoptysis (50%, n=6) while major imaging findings were cavitation (83.3%, n=10; two containing fungal ball), fibrosis (83.3%, n=10) and pleural thickening (75.0%, n=9). The Aspergillus IgG & IgM LFD was positive in 14 (13.1%), 11 (78.6%) in CPA and 3 (21.4%) in non-CPA cases (PPV: 78.6% and NPV: 98.9%). Sputum Aspergillus culture was positive in 32 (29.9%) cases, 9 in CPA cases.
Conclusion:
CPA is rarely considered as a differential diagnosis of PTB in Ghana. However, this study reveals that more than one in ten patients presenting with PTB-like symptoms may have CPA. Aspergillus IgG & IgM LFD is a rapid and simple tool that allows for early screening of CPA among presumed PTB relapse patients prior to imaging findings and should be prioritized.
Abstract Number: 16
Conference Year: 2022
Link to conference website: https://aaam2022.org/
URL Conference abstract: