Global burden of chronic pulmonary aspergillosis complicating sarcoidosis

Abstract

Chronic pulmonary aspergillosis (CPA) may complicate pulmonary sarcoidosis. We re-estimated the global burden of sarcoidosis and the burden of CPA complicating sarcoidosis.We searched the literature and reference lists of retrieved papers to identify all published sarcoidosis incidence and prevalence data. We estimated the frequency of CPA from 11 papers relating to .3,000 patients with sarcoidosis to derive CPA patient numbers. We applied an annual attrition rate of 15% (range 10-25%) to estimate the global burden of CPA.We estimate that the annual incidence of sarcoidosis is 344,000 patients worldwide and the prevalence is ,1,238,000 cases, distributed as follows: 165,979 in Europe, 224,000 in the Americas, 492,892 in Africa, 80,023 in the Eastern Mediterranean, 41,660 in the West Pacific and 234,010 in Southeast Asia. CPA complicates sarcoidosis in 3-12% of cases. Using a 6% frequency, we estimate a global burden of 71,907 (range 35,954-143,815 (3-12%)) CPA cases complicating sarcoidosis, with 24% and 37% of cases estimated to be present in the Americas and Africa, because of the higher incidence of sarcoidosis in black people.As CPA responds to long-term antifungal therapy, which may prevent life-threatening haemoptysis, screening periodically for CPA in those with pulmonary sarcoidosis may be important, especially in patients requiring corticosteroid therapy.

Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

“…TB, NTM infection and ABPA remain the predominant risk factors for development of CPA, with COPD, prior pneumothorax or treated lung cancer also relatively common [26,62]. Fibrocystic sarcoidosis [19], ankylosing spondylitis, pneumoconiosis [63] and progressive massive fibrosis in silicosis [64,65] may also be implicated [40,55,[66][67][68][69]. Changes secondary to the Aspergillus infection itself range from the typical appearance of a fungus ball within a lung cavity (single or simple aspergilloma) to complex pleuroparenchymal features that are related to a progressive destructive cavitary disease [61].…”

“…Several prospective treatment studies were undertaken [14][15][16]. The global burden of CPA following pulmonary TB ( prevalence of 1.74 million), complicating allergic bronchopulmonary aspergillosis (ABPA) (CPA prevalence of 411 000) and sarcoidosis (CPA prevalence of 72 000) have been estimated [17][18][19], showing the extent of the problem internationally.…”

Burden of Serious Fungal Diseases in Romania

“…The total number of notified tuberculosis (TB) cases was obtained from Tuberculosis Surveillance and Monitoring in Europe 2017 report issued by ECDC & WHO [17], whereas the estimation of cases of chronic pulmonary aspergillosis (CPA) after TB was done as previously described [18].…”

Diagnosis and treatment of chronic pulmonary aspergillosis: clinical guidelines of European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society

“…Выполнено несколько проспективных исследований по лечению аспергил леза [14][15][16]. Подсчитан ущерб от ХЛА в мировом масштабе, включая ХЛА на фоне туберкулеза легких (n = 1,74 млн), аллергического бронхолегочного аспергиллеза (АБЛА) (n = 411 000) и саркоидоза (n = 72 000) [17][18][19], при этом показано всемирное значение данной проблемы.…”