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

Author:

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

Abstract:

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.

Presenter email address: firas.maghrabi@doctors.org.uk

Abstract Number: 9599

Link to conference website:

Link Conference abstract: 

ECCMID 2020

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