Importance of Aspergillus-Specific Antibody Screening for Diagnosis of Chronic Pulmonary Aspergillosis after Tuberculosis Treatment: A Prospective Follow-Up Study in Ghana

Ocansey, Bright K.; Otoo, Benjamin; Gbadamosi, Hafisatu; Afriyie-Mensah, Jane S; Opintan, Japheth A.; Kosmidis, Chris; Denning, David W.

doi:10.3390/jof9010026

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…While multiple studies have now reported CPA in LMICs, 10,20,[45][46][47][48] they fail to offer diagnoses in patients who test negative-other causes of chronic respiratory illness are likely in their respective settings. Since CPA has many presentations, which are often insidious, the differential diagnosis will be broad, and the archetypal presentation of a productive cough lasting several months with nonspecific constitutional symptoms could result from both infectious and noncommunicable diseases.…”

Section: Differential Diagnosismentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Evans,

Lawal,

Kosmidis

et al. 2023

Semin Respir Crit Care Med

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Chronic pulmonary aspergillosis (CPA) refers to a number of clinical syndromes resulting from the presence and local proliferation of Aspergillus organisms in the lungs of patients with chronic lung disease. CPA is more common than was realized two decades ago. Recognition remains poor, despite recent studies from many countries highlighting the high prevalence in at-risk populations. In low- and middle-income countries, CPA may be misdiagnosed and treated as tuberculosis (TB). In addition, CPA may develop following successful TB treatment. The coronavirus disease pandemic has resulted in significant disruption to provision of TB care, likely leading to more extensive lung damage, which could increase the risk for CPA.Although CPA refers to various syndromes, the classic presentation is that of chronic cavitary pulmonary aspergillosis, which manifests as one or more progressive cavities with or without a fungal ball, accompanied by systemic and respiratory symptoms for at least 3 months. Diagnosis relies on Aspergillus immunoglobulin G in serum, as sputum culture lacks sensitivity. Differential diagnosis includes mycobacterial infection, bacterial lung abscess or necrotizing pneumonia, lung cancer, and endemic fungi.The aim of antifungal treatment in CPA is to improve symptoms and quality of life, and to halt progression, and possibly reverse radiological changes. Current recommendations suggest treatment for 6 months, although in practice many patients remain on long-term treatment. Improvement may manifest as weight gain and improvement of symptoms such as productive cough, hemoptysis, and fatigue. Surgical management should be considered in cases of diagnostic uncertainty, in significant hemoptysis, and when there is concern for lack of response to therapy. Itraconazole and voriconazole are the first-line azoles, with more experience now accumulating with posaconazole and isavuconazole. Side effects are frequent and careful monitoring including therapeutic drug monitoring is essential. Intravenous antifungals such as echinocandins and amphotericin B are used in cases of azole intolerance or resistance, which often develop on treatment. Relapse is seen after completion of antifungal therapy in around 20% of cases, mostly in bilateral, high-burden disease.Several research priorities have been identified, including characterization of immune defects and genetic variants linked to CPA, pathogenetic mechanisms of Aspergillus adaptation in the lung environment, the contribution of non-fumigatus Aspergillus species, and the role of new antifungal agents, immunotherapy, and combination therapy.

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Section: Differential Diagnosismentioning

confidence: 99%

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Evans,

Lawal,

Kosmidis

et al. 2023

Semin Respir Crit Care Med

Self Cite

View full text Add to dashboard Cite

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Characterization of Treatment Response Outcomes in Chronic Pulmonary Aspergillosis: CPAnet Definitions Versus the Existing Criteria

Sehgal¹,

Arora²,

Cornely³

et al. 2023

Mycopathologia

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The Impact of the Fungal Priority Pathogens List on Medical Mycology: A Northern European Perspective

Arendrup,

Armstrong-James,

Borman

et al. 2024

Open Forum Infectious Diseases

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Fungal diseases represent a considerable global health concern, affecting over one billion people annually. In response to this growing challenge, the World Health Organization introduced the pivotal fungal priority pathogens list (FPPL) in late 2022. The FPPL highlights the challenges in estimating the global burden of fungal diseases and antifungal resistance (AFR), as well as limited surveillance capabilities and lack of routine AFR testing. Furthermore, training programmes should incorporate sufficient information on fungal diseases, necessitating global advocacy to educate healthcare professionals and scientists. Established international guidelines and the FPPL are vital in strengthening local guidance on tackling fungal diseases. Future iterations of the FPPL have the potential to refine the list further, addressing its limitations and advancing our collective ability to combat fungal diseases effectively. Napp Pharmaceuticals Limited (Mundipharma UK) organised a workshop with key experts from Northern Europe to discuss the impact the FPPL will have on regional clinical practice.

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Importance of Aspergillus-Specific Antibody Screening for Diagnosis of Chronic Pulmonary Aspergillosis after Tuberculosis Treatment: A Prospective Follow-Up Study in Ghana

Cited by 3 publications

References 31 publications

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Chronic Pulmonary Aspergillosis: Clinical Presentation and Management

Characterization of Treatment Response Outcomes in Chronic Pulmonary Aspergillosis: CPAnet Definitions Versus the Existing Criteria

The Impact of the Fungal Priority Pathogens List on Medical Mycology: A Northern European Perspective

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