PT  - JOURNAL ARTICLE
AU  - Iain D. Page
AU  - Rosemary Byanyima
AU  - Sharath Hosmane
AU  - Nathan Onyachi
AU  - Cyprian Opira
AU  - Malcolm Richardson
AU  - Richard Sawyer
AU  - Anna Sharman
AU  - David W. Denning
TI  - Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation
AID  - 10.1183/13993003.01184-2018
DP  - 2019 Jan 01
TA  - European Respiratory Journal
PG  - 1801184
4099  - http://erj.ersjournals.com/content/early/2019/01/02/13993003.01184-2018.short
4100  - http://erj.ersjournals.com/content/early/2019/01/02/13993003.01184-2018.full
AB  - Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis, with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary tuberculosis underwent clinical assessment, chest X-ray and Aspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including CT thorax in 73 with suspected CPA. CPA was diagnosed in patients without active tuberculosis who had raised Aspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%) resurvey patients (95% confidence interval 2.8% - 7.9%). CPA was significantly more common in those with chest X-ray cavitation (26% versus 0.8%, p<0.001), but possibly less frequent in HIV co-infected patients (3% versus 6.7%, p=0.177). The annual rate of new CPA development between surveys was 6.5% in those with chest X-ray cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening on chest X-ray had 100% negative predictive value for CPA. The combination of raised Aspergillus-specific IgG, chronic cough or haemoptysis and chest X-ray cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis.CPA commonly complicates treated pulmonary tuberculosis with residual chest X-ray cavitation. Chest X-ray alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Page reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study; grants and non-financial support from Serion, grants and non-financial support from Dynamiker, non-financial support from Genesis, non-financial support from OLM Medical, grants from British Infection Association, grants from British Society for Medical Mycology, grants from International Society for Human and Animal Mycology, grants from European Society for Clinical Microbiology and Infectious Diseases, grants from Conference for Retroviruses and Opportunistic Infections, outside the submitted work.Conflict of interest: Dr. Byanyima reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study.Conflict of interest: Dr. Hosmane reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study.Conflict of interest: Dr. Onyachi reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study.Conflict of interest: Dr. Opira reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study.Conflict of interest: Dr. Richardson reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study; personal fees and other from Gilead Sciences Europe, personal fees from MSD, personal fees from Basilea, outside the submitted work.Conflict of interest: Dr. Sawyer reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study.Conflict of interest: Dr. Sharman reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study.Conflict of interest: Dr. Denning reports grants from Astellas Pharma Europe, non-financial support from Siemens, grants and non-financial support from Gulu-Manchester Link, during the conduct of the study; other from F2G, personal fees from Scynexis, personal fees from Cidara, personal fees from Biosergen, personal fees from Quintiles, personal fees from Pulmatrix, personal fees from Pulmocide, personal fees from Zambon, personal fees from Fujifilm, personal fees from Astellas, personal fees from Dynamiker, personal fees from Gilead, personal fees from Merck, personal fees from Pfizer, outside the submitted work; and He is a longstanding member of the Infectious Disease Society of America Aspergillosis Guidelines group, the European Society for Clinical Microbiology and Infectious Diseases Aspergillosis Guidelines group and the British Society for Medical Mycology Standards of Care committee.