Serological Changes in Anti-Aspergillus IgG Antibody and Development of Chronic Pulmonary Aspergillosis in Patients Treated for Pulmonary Tuberculosis

Abstract

Chronic pulmonary aspergillosis (CPA) is an important infection to understand in survivors of pulmonary tuberculosis (PTB). However, limited data are available regarding CPA development and its predisposing factors following PTB. We investigated the development of, and the predisposing factors for, CPA following the completion of PTB treatment. A total of 345 patients, with newly diagnosed culture-positive PTB (between January 2015 and December 2018), were included. Enrolled cases were categorized into four groups (persistently seronegative, seroconversion, seroreversion, and persistently seropositive) according to serological changes in their anti-Aspergillus IgG antibodies before and after PTB treatment. The patients were followed up for a median of 25.8 months. Ten (10/345, 2.9%) patients developed CPA at a median of 13.5 months after treatment completion, including seven (7/24, 29.2%) and three (3/73, 4.1%) in the seroconversion and persistently seropositive groups, respectively. Upon multivariate analysis, seroconversion of anti-Aspergillus IgG antibody (adjusted hazard ratio [HR], 25.21; 95% confidence interval [CI], 6.11–103.99; p < 0.001) and diabetic status (adjusted HR, 7.54; 95% CI, 1.93–29.50; p = 0.004) were independently associated with CPA development. The development of CPA in patients with PTB was observed in 2.9% of patients during post-treatment follow-up, and this was significantly associated with both the seroconversion of anti-Aspergillus IgG antibody and diabetes characteristics.

New estimation of the prevalence of chronic pulmonary aspergillosis (CPA) related to pulmonary TB – a revised burden for India

“…Anti- Aspergillus IgG antibody is also not specific for CPA. Detectable antibodies are also found in those recovering from invasive aspergillosis, chronic invasive Aspergillus rhinosinusitis or granulomatous sinusitis, allergic bronchopulmonary aspergillosis, and Aspergillus bronchitis (usually seen in those with bronchiectasis), as well as some healthy people ( Kim et al., 2022 ). In healthy populations, Aspergillus IgG was detectable in one of 222 (0.5%) in France ( Guitard et al., 2012 ), 11 of 90 (12%) in Indonesia ( Setianingrum et al., 2020 ), six of 42 (14%) in Belgium ( Van Hoeyveld et al., 2006 ), and four of 150 (2.7%) in the UK ( Wilopo et al., 2020 ).…”

“…CPA, usually with an aspergilloma, was found in 8.3% of 350 previously treated PTB patients who were subsequently hospitalized in Rio de Janeiro, Brazil over an unclear time frame ( Ferreira-Da-Cruz et al., 1988 ). A prospective study in Seoul, South Korea found 3% of culture-proven PTB cases to have CPA in the 2 years after completion of ATT ( Kim et al., 2022 ). For consistency, our study used 1.5% annually, and modeled the overall 5-year-period prevalence of CPA after TB using 7.5%.…”

Chronic pulmonary aspergillosis incidence in newly detected pulmonary tuberculosis cases during follow-up

“…In the latter study, there was higher resolution rate of primary cavity after TB treatment in the 'seroconversion' group (40%) and 'persistently seronegative' group (75.9%) as compared to 'seroreversion' group (0%) and 'persistently seropositive' group (22.7%). 9 In our study 5/8 patients (~63%. 95% CI: 24.5-94.5) who had 'self-resolving CPA" had resolution of their consolidation (without development of new cavity) at the end-of-therapy as compared to their baseline chest images.…”

Burden, clinical features, and outcomes of post-tuberculosis chronic obstructive lung diseases

“…Recently, Page et al [61] found a CPA incidence of 6.5% in Ugandan PTLD patients on a resurvey after 2 years. Kim et al [62] reported a CPA incidence of 2.9% during a 2-year follow-up in individuals with PTLD. Interestingly, patients with active PTB also have a higher occurrence of A. fumigatus coinfection.…”