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Risk factors and treatment outcomes in patients with chronic pulmonary aspergillosis

Kshitij Agarwal, Anuradha Chowdhary, M. Rahman, Anil Chaudhry, S.N. Gaur
European Respiratory Journal 2016 48: PA2647; DOI: 10.1183/13993003.congress-2016.PA2647
Kshitij Agarwal
1Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, DelhiIndia
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Anuradha Chowdhary
2Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, DelhiIndia
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M. Rahman
3Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, DelhiIndia
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Anil Chaudhry
4Chest and Tuberculosis, Rajan Babu Institute of Pulmonar Medicine and Tuberculosis, Delhi, DelhiIndia
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S.N. Gaur
1Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, DelhiIndia
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Abstract

Background: Chronic pulmonary aspergillosis (CPA) is still under-diagnosed in high tuberculosis (TB) burden areas like India where similar clinical presentation and disregard for underlying risk factors lead to its misdiagnosis as the latter.

Aim: To evaluate patient characteristics and treatment outcomes in CPA patients

Methods: Consecutive patients with a differential diagnosis of CPA enrolled from Jan. 2012-Dec. 2013 were administered oral itraconazole (ITZ) or voriconazole. Weight, BMI, haemoglobin (Hb), total leucocyte count (TLC), specific IgG, precipitins, CRP, sputum fungus and radiology were followed till 2 years after the end of treatment. Negative specific IgG was taken as end-point of therapy.

Results: CPA was diagnosed in 24(70.5%) patients including 10 CCPA, 9 CNPA, 3 CFPA and 2 simple aspergilloma. Mean age was 47.2±10.9years. Average 2.1 risk factors were present per patient; TB was the commonest risk factor (29.3%) but ABPA, sarcoidosis and diabetes mellitus were significantly associated with development of CPA. Cavitation was noted in 29% and aspergilloma in 12%. Specific IgG and serum precipitins were raised in 79% and CRP 92%. A. fumigatus was isolated in 80%. Both drugs exerted similar but significant improvements in weight (51.8±7 vs 56.3±8 Kg), BMI (18.7±3.1 vs 20.3±3.0 Kg/m2), Hb (11.3±1.9 vs 12.3±1.7 g/dL), TLC (10.2±3.1 vs 7.9±2.6×103/µL), precipitins and specific IgG (69.1; 26.5-84.2 vs 29.6; 0-39.3 MgA/L). Two cases on ITZ relapsed at 12 months; no deaths were reported.

Conclusions: CPA should be investigated in patients with multiple risk factors. Triazole antifungals are effective in treatment. Specific IgG titers can be used to assess disease activity and response to treatment.

  • Infections
  • Chronic disease
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Risk factors and treatment outcomes in patients with chronic pulmonary aspergillosis
Kshitij Agarwal, Anuradha Chowdhary, M. Rahman, Anil Chaudhry, S.N. Gaur
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2647; DOI: 10.1183/13993003.congress-2016.PA2647

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Risk factors and treatment outcomes in patients with chronic pulmonary aspergillosis
Kshitij Agarwal, Anuradha Chowdhary, M. Rahman, Anil Chaudhry, S.N. Gaur
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2647; DOI: 10.1183/13993003.congress-2016.PA2647
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