Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern

Abstract

How common is CPA after treated PTB? CPA is a progressive respiratory syndrome that largely occur in immunocompetent or subtly immunocompromised individuals with underlying structural lung diseases, most commonly treated TB [11]. Residual cavities remain in between 20% to 40% of lungs of patients following treatment for PTB [12,13]. Cavitation and ectatic lesions in PTBLD allows saprophytic colonisation and growth of Aspergillus species following inhalation of infectious spores from the environment. This leads to expansion of the existing or creation of new cavities with associated parenchymal and pleural damage [11]. A complex mixture of Aspergillus hyphae, tissue debris, inflammatory cells, and mucin known as a fungal ball (aspergilloma) may form in these cavities [11]. The significance of treated PTB in the pathogenesis of CPA was established by a large cohort study across over 50 clinics in Great Britain in the mid-to late 1960s [14]. In this landmark study, 544 patients who had a persistent cavity of at least 2.5 cm in diameter and negative M. tuberculosis bacilli in their sputum for at least a year were studied. About 25% of the patients had positive Aspergillus precipitins (i.e., precipitating immunoglobulin M [IgM] and immunoglobulin G

Misdiagnosis of chronic pulmonary aspergillosis as pulmonary tuberculosis at a tertiary care center in Uganda: a case series

“…CPA affects an estimated 3 million people worldwide [ 6 , 7 ] and 62,000 people in Uganda [ 8 ]. More than half of cases of CPA occur as a complication of treated PTB; CPA and PTB can co-exist, posing a challenge in distinguishing the two clinically and on radiology [ 9 ]. This group of patients is often misdiagnosed and managed as smear-negative PTB [ 10 , 11 ].…”

Pulmonary aspergilloma on transthoracic ultrasound

“…Initial clinical presentation of CPA and PTB are often alike. In resource-limited facilities testing for immunoglobulin G (IgG) antibodies against A. fumigatus may often not be available, and thus CPA may often be undiagnosed or misdiagnosed as "smear-negative PTB" and/or "relapse" of TB in endemic settings [5]. Post-TB lung disease (PTLD) is responsible for a notable number of chronic lung diseases worldwide [6] and its wide-ranging consequences are yet to be understood fully to improve TB treatment outcomes [7].…”

Aspergillus-Associated Endophenotypes in Bronchiectasis

“…They represent a localized mass of hyphae and cellular debris, often developing in areas of lung with preexisting structural damage, including lung cavities in patients with post-tuberculosis bronchiectasis. 47,57 Most remain asymptomatic and are detected incidentally; however, life-threatening hemoptysis is a dreaded complication if fungal hyphae invade the bronchial vasculature. In this setting, surgical resection of the mass or embolization of the involved vasculature may be necessary, especially with a large or otherwise intermittent frequent bleeds.…”