Risk factors and treatment outcomes in patients with chronic pulmonary aspergillosis

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.