The risk factors for developing of chronic pulmonary aspergillosis in nontuberculous mycobacteria patients and clinical characteristics and outcomes in chronic pulmonary aspergillosis patients coinfected with nontuberculous mycobacteria

Abstract

Patients with chronic pulmonary aspergillosis (CPA) have a poor prognosis and CPA occurs in patients with various underlying diseases. Recently, the number of patients with CPA complicated by nontuberculous mycobacteria (NTM) has increased. Additionally, complications of both diseases have several problems like drug interactions. Since the impact of NTM on the outcome of CPA is not well understood, we investigated the risk factors for developing CPA and the clinical characteristics of CPA patients with or without NTM. We retrospectively investigated the medical records of NTM and CPA patients who were admitted to Nagasaki University Hospital between April 2008 and September 2013. Comorbid diseases, causative microorganisms, radiological findings, and outcomes were evaluated. During the study period, 82 and 41 patients were diagnosed as having NTM and CPA, respectively. Nine patients were coinfected with NTM and CPA, and cavitary type NTM and steroid usage were independent risk factors of development of CPA. Mortality rates in the coinfection group were significantly higher than those of the NTM without CPA group (P = .003, log-rank test). The rate of treatment initiation in the co-infection group (33.3%) was significantly lower than in the CPA without NTM group (84.4%) (P = .006). However, there were no significant differences in cumulative survival rate between both groups (P = .760, log-rank test). Cavity formation and steroid usage were the independent risk factors for NTM patients to develop CPA within long observation period, and development of CPA made outcomes poor. It is important to diagnose the development of CPA early and initiate treatment for CPA.

Predictors of mortality in chronic pulmonary aspergillosis

“…We found only nine studies with sample sizes of 11-194 subjects reporting divergent data on the survival of CPA patients, with 5-year survival ranging from 17.5% to 85% [12][13][14][15][16][17][18][19][20], as summarised in table 1.…”

Characterization of patients with chronic pulmonary aspergillosis according to the new ESCMID/ERS/ECMM and IDSA guidelines

“…Symptoms include weight‐loss, severe fatigue, shortness of breath, and haemoptysis leading to a 5‐year case fatality rate of 20‐50% even when treated . Major risk factors are underling pulmonary diseases, especially those leading to a structural damage of the lung such as tuberculosis, non‐tuberculous mycobacteria (NTM) pulmonary diseases, chronic obstructive pulmonary disease (COPD) and other chronic pulmonary diseases . Despite common understanding CPA is not a disease of the severely immunocompromised host such as invasive aspergillosis, although the subacute invasive pulmonary aspergillosis (SAIA; formally called chronic necrotizing pulmonary aspergillosis), which is a sub‐entity of CPA, is usually seen in patients with a mild immunosuppression.…”

“…[6][7][8][9] Major risk factors are underling pulmonary diseases, especially those leading to a structural damage of the lung such as tuberculosis, non-tuberculous mycobacteria (NTM) pulmonary diseases, chronic obstructive pulmonary disease (COPD) and other chronic pulmonary diseases. [10][11][12][13] Despite common understanding CPA is not a disease of the severely immunocompromised host such as invasive aspergillosis, although the subacute invasive pulmonary aspergillosis (SAIA; formally called chronic necrotizing pulmonary aspergillosis), which is a sub-entity of CPA, is usually seen in patients with a mild immunosuppression. All other forms of CPA including single aspergilloma, aspergillus nodule(s), chronic cavitary pulmonary aspergillosis (CCPA), and chronic fibrosing pulmonary aspergillosis (CFPA) are exclusively seen in patients with underlying respiratory disorders without severe immunosuppression.…”

Invasive Tracheobronchial Aspergillosis with Bronchial Ulcers Complicated by Nontuberculous Mycobacterial Disease

“…Pulmonary aspergillosis rarely but occasionally leads to ulcerative lesions in the trachea and bronchus, and when it does, it is considered to be invasive tracheobronchial aspergillosis (ITBA) (1). In addition, ITBA complicated by nontuberculous mycobacteria (NTM) is rare, although coinfection of Aspergillus and NTM is not uncommon (2). The use of therapeutic agents is limited due to drug interactions.…”