The burden of chronic pulmonary aspergillosis on the respiratory service at a district general hospital


Firas Maghrabi *1, Ruth Cade 2, Chris Kosmidis 1, Ram Sundar 2, David W. Denning 1

Author address:

1 University of Manchester, National Aspergillosis Centre, Manchester, United Kingdom; 2
Royal Albert Edward Infirmary, Wigan, United Kingdom

Full conference title:

European Congress of Clinical Microbiology and Infectious Diseases 2020

Date: 2 July 2020


Background: Wigan is a town located 17 miles North West of The City of Manchester with a population just over 325,000. It was known as major mill town and coal mining district and is covered by Wigan Infirmary, a district general hospital (DGH) with 513 beds.

A recent report from the National Aspergillosis Centre (NAC) based in Manchester, UK; highlighted Wigan as the home of the highest number of referrals with Chronic Pulmonary Aspergillosis (CPA) with 63 patients of 522 (12%) under active follow up. This was a significantly higher case burden than expected for a DGH that warranted further investigation.

Materials/methods: A retrospective analysis of electronic case-notes of all patients admitted to Wigan Infirmary with a diagnosis of CPA or invasive pulmonary aspergillosis (IPA) within a six-year period from January 2013 to December 2018. We also reviewed the case-notes of all the outpatients diagnosed with CPA and referred to the NAC during this period.

Results: Patients were diagnosed with CPA and classified according to the ESCMID guidelines. 41 patients were admitted during this period, 37 with CPA and 4 with IPA. 78 were diagnosed with CPA as outpatients and received treatment at the NAC.

Overall, 63% had COPD, 85% had a smoking history of >10 pack years. 68% of patients had been treated with inhaled steroids. 87% of patients lived in postcodes in the most deprived 50% of areas for health and disability according to the 2015 English Indices of Deprivation, with 24% of patients living in the most deprived areas.

Mortality was high, 21% of inpatients died before they could be referred to the NAC. 43% of outpatients with CPA died by the time of the analysis.

Conclusions: The burden of pulmonary aspergillosis is higher than expected in the Wigan area with an estimated prevalence of 35/100,000 population, compared with the estimated national burden of 5.7/100,000. The reasons for the raised burden are unclear, but probably health deprivation, a high prevalence of chronic lung disease and smoking related morbidity and mortality are factors. Further compartive studies from similar populations are required to understand the burden of CPA further.

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Abstract Number: 9599

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