Chronic pulmonary aspergillosis complicating treated pulmonary tuberculosis in Gulu, Uganda

Ref ID: 19401

Author:

I. D. Page,1 J. Opwonya,2 N. Onyachi,3 C. Opira,4 E. Odongo-
Aginya,5 A. Mockridge,1 G. Byrne1 and D. W. Denning1

Author address:

1University of Manchester, United Kingdom; 2Gulu District Health
Office, Uganda; 3Gulu Regional Referral Hospital, Uganda; 4St.
Mary’s Hospital, Lacor, Gulu, Uganda and 5Gulu University,
Uganda

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Objectives 15-25% of Africans treated appropriately for pulmonary
tuberculosis (PTB) die within a few years of completing treatment.
Chronic Pulmonary Aspergillosis (CPA) may be responsible for many
of these deaths. CPA is a progressive condition leading to prolonged
fatigue and breathlessness then death from respiratory failure or sud-
den massive haemoptysis. A recent controlled trial in India demon-
strated treatment with generic fixed dose Itraconazole is well tolerated
and leads to stabilization or improvement in 76% of patients.
In 1970 36% of 399 British patients with residual cavities after
treated PTB were found to have precipitating antibodies to Aspergillus
. Half of these developed an aspergilloma within a 2 year follow
up period. Our group has recently estimated the global annual inci-
dence of CPA at 372,000 cases, with a global five year period preva-
lence of 0.8 to 1.3 million cases and 43 cases per 100,000 in a
representative sub-saharan country (DR Congo). This estimate was
based on the results of the 1970 survey and current published data
on the frequency of residual cavitation after completing PTB treat-
ment. It does not take account of the possibility of either increased susceptibility or reduced chronic inflammation with fibrosis due to
HIV/AIDS.
Methods We aim to measure the prevalence of CPA in Gulu,
Uganda. Diagnosis requires a combination of a) chronic respiratory
symptoms, b) aspergilloma, pleural thickening or progressive cavita-
tion on chest x-ray and c) Aspergillus specific antibodies. We recruited
400 adult patients (200 HIV positive and 200 HIV negative) who
completed PTB treatment within the last 7 years, plus 300 healthy
controls, between October 2012 and January 2013. Smear negative
cases were accepted only if there was a complete resolution of symp-
toms with treatment.
Results Chronic respiratory symptoms were present in 238 patients
(59%). This included haemoptysis in 9 (2%), cough in 77 (19%), fati-
gue in 150 (37%) and breathlessness in 149 (37%). Chest x-ray
demonstrated cavitation in 97 (24%), pleural thickening in 69 (17%)
and aspergilloma in 12 (3%).
Mean CD4 count in the HIV positive group was 415 cells/lL and
30 (15%) of the HIV positive patients had CD4 < 200 cells/lL. There was no statistically significant difference in symptoms between HIV positive and negative groups. Cavitation on chest x-ray was more common in HIV negative patients than HIV positive patients (31% vs 18% p = 0.004). Overall 60 (15%) of patients had both chronic symptoms and x- ray changes consistent with CPA. There was no statistically signifi- cant difference in this rate between HIV positive and negative groups. Conclusions These initial results suggest that CPA may well be a common complication of treated pulmonary tuberculosis. Serum has been taken from patients and will be screened for antibodies to Aspergillus . We plan to perform a re-survey of this cohort in 2014 with repeat chest x-ray and serology. This will allow us to identify pro- gression of cavitation. We will then be able to state the frequency of CPA as a complication of PTB in this African population.

Abstract Number: p127

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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