Chronic pulmonary aspergillosis in patients with active pulmonary tuberculosis with persisting symptoms in Uganda

Martha Namusobya, Felix Bongomin, John Mukisa, William Kane Olwit, Charles Batte, Claudine Mukashyaka, Emmanuel Mande, Richard Kwizera, David W. Denning, Joshua Rhein, Shailendra Prasad, Christine Sekaggya-Wiltshire

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The occurrence of chronic pulmonary aspergillosis (CPA) among drug sensitive pulmonary tuberculosis (PTB) patients on optimal therapy with persistent symptoms was investigated. Methods: We consecutively enrolled participants with PTB with persistent pulmonary symptoms after 2 months of anti-TB treatment at Mulago Hospital, Kampala, Uganda, between July 2020 and June 2021. CPA was defined as a positive Aspergillus-specific IgG/IgM immunochromatographic test (ICT), a cavity with or without a fungal ball on chest X-ray (CXR), and compatible symptoms >3 months. Results: We enrolled 162 participants (median age 30 years; IQR: 25–40), 97 (59.9%) were male, 48 (29.6%) were HIV-infected and 15 (9.3%) had prior PTB. Thirty-eight (23.4%) sputum samples grew A. niger and 13 (8.0%) A. fumigatus species complexes. Six (3.7%) participants had intracavitary fungal balls and 52 (32.1%) had cavities. Overall, 32 (19.8%) participants had CPA. CPA was associated with prior PTB (adjusted odds ratio [aOR]: 6.61, 95% CI: 1.85–23.9, p =.004), and far advanced CXR changes (aOR: 4.26, 95% CI: 1.72–10.52, p =.002). The Aspergillus IgG/IgM ICT was positive in 10 (31.3%) participants with CPA. Conclusions: Chronic pulmonary aspergillosis may cause persistent respiratory symptoms in up to one-fifth of patients after intensive treatment for PTB. The Aspergillus IgG/IgM ICT positivity rate was very low and may not be used alone for the diagnosis of CPA in Uganda.

Original languageEnglish (US)
Pages (from-to)625-634
Number of pages10
JournalMycoses
Volume65
Issue number6
DOIs
StatePublished - Jun 2022

Bibliographical note

Funding Information:
Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under grant #D43TW009345 awarded to the Northern Pacific Global Health Fellows Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health We thank the MNRH TB unit for hosting the study. We are grateful to the study team based there (Betty Namara, Jane Oyeru, Sam Nyole and Esther Mbabazi) who were key in participant identification, recruitment and retention. We are grateful to the Infectious Diseases Institute (IDI) translational laboratory for managing the study samples. An oral abstract of this work was presented at the 10th Trends in Medical Mycology (TIMM) Conference that happened in October 2021 in Aberdeen, Scotland.

Funding Information:
Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under grant #D43TW009345 awarded to the Northern Pacific Global Health Fellows Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Publisher Copyright:
© 2022 Wiley-VCH GmbH.

Keywords

  • Uganda
  • chronic pulmonary aspergillosis
  • persistent symptoms
  • pulmonary tuberculosis

PubMed: MeSH publication types

  • Journal Article

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