P128 Chronic pulmonary aspergillosis in a Tuberculosis c enter of Assam—a 2-year study

Abstract

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objectives Chronic pulmonary aspergillosis is a slow and progressive lung disease that occurs in apparently immune-competent patients. Pulmonary tuberculosis is considered to be a major predisposing factor. Early diagnosis of the condition can improve morbidity and mortality. As the number of studies to detect this disease in India is sparse, this study was undertaken in District Tuberculosis center attached to Assam Medical College and Hospital, Dibrugarh to find out the occurrence of chronic pulmonary aspergillosis in treated pulmonary TB patients. Methods This prospective hospital-based cross-sectional study was done in Assam Medical College and Hospital, Dibrugarh from December 2015-November 2017. Every consecutive pulmonary TB case after completion of intensive therapy attending the outpatient department with respiratory symptoms was included in the study. Cases were identified with clinical, serological/mycological, and radiological criteria. Results A total of 26 cases of CPA were confirmed out of 211 enrolled cases. Positivity rate of CPA in the enrolled patients was 12.3% (95% CI 8.19-17.51%). The hospital-based occurrence rate was found to be 6/1000 (95% CI 3.8-8.5) in the outdoor attendants in DTC, Dibrugarh. Most of the cases (88.46%) were late cases presenting with aspergilloma. Majority (51.72%) of the aspergilloma cases were detected within 5 years of diagnosis of PTB. Very few (15.38%, n = 4) early cases were detected. The sensitivity of the ELISA test (DRG, Germany) was found to be 72.72% as compared with reference Immunocap method used in this study. A section (37.90%) of the patients with fungal ball was seronegative by Aspergillus fumigatus serological test. Two of them were positive for Aspergillus flavus in sputum culture. Conclusion A serological test to detect Aspergillus flavus IgG may complement the Aspergillus fumigatus IgG test in detecting CPA. CPA is a neglected disease with a high morbidity and mortality. Routine follow-up protocol for the cavitary patients in tuberculosis center by a sensitive serological test for a minimum period of 5 years may be necessary for early detection of cases in PTB high prevalence countries.