Risk stratification for the development of chronic pulmonary aspergillosis in patients with Mycobacterium avium complex lung disease

Patient background and prognosis of chronic pulmonary aspergillosis in fibrosing interstitial lung disease

“…In general, in reports of the background of patients with CPA, older age (median: 68.5–73.4 years), male sex (73.9–80.4%), and a smoking history (69.7–71.1%) were predominant, as in a present study. [ 4 , 7 , 8 , 15 ] These characteristics were similar in IPF cohorts. [ 16 , 17 ] When limited to CPA associated with ILD, the proportion of patients with IPF was 60.0% as reported by Kurosaki et al [ 7 ] and 34.4% in the present study.…”

“…Although the presence of anti- Aspergillus antibody can differentiate between infected and colonized patients with a relatively high positive predictive value, some patients with a CPA diagnosis might have colonization or false-positive results for anti- Aspergillus antibody. [ 15 ] Third, we could not quantitatively assess the HRCT patterns, and this will be an issue for further investigation. Fourth, CRP, being the single independent predictor factor for poor prognosis might be not a satisfactory finding.…”

Impact of emphysema on the prognosis of Mycobacterium avium complex pulmonary disease

“…MAC (n = 3), Pseudomonas aeruginosa (n = 1), Klebsiella pneumoniae (n = 1), methicillin-susceptible Staphylococcus aureus (n = 1), Stenotrophomonas maltophilia (n = 1), and Escherichia coli (n = 1) were identified at the diagnosis of fatal pneumonia (Table 3). According to previous reports, CPA development affects MAC-PD prognosis [17,18]. Eleven of 174 patients (6.3%) developed CPA; 7 of 39 (17.9%) in the MAC-PD with emphysema group and 4 of 135 (3.0%) in the MAC-PD without emphysema group (Figure 4).…”

“…Approximately 5.5%-11% of patients with NTM-PD develop CPA during long-term observation [20,37]. Furuuchi et al reported that emphysema is one of the risk factors for CPA development in patients with MAC-PD [18]. Despite there being no data directly estimating the prevalence of CPA in patients with COPD [38], Everaerts et al reported higher levels of sputum galactomannan, a polysaccharide cell wall component of Aspergillus species, in patients with COPD-bronchiectasis overlap in comparison with COPD patients without J o u r n a l P r e -p r o o f bronchiectasis; values were especially higher in patients with COPDbronchiectasis overlap who received systemic corticosteroid treatment [39].…”

“…We focused on emphysema, which is a major pathological feature in COPD. Emphysema and MAC-PD are risk factors for chronic pulmonary aspergillosis (CPA), and CPA is strongly associated with poor prognosis [16][17][18].…”