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. 2021 Apr;64(4):412-419.
doi: 10.1111/myc.13229. Epub 2020 Dec 28.

Sensitization to A fumigatus in subjects with non-cystic fibrosis bronchiectasis

Inderpaul Singh Sehgal  1 , Sahajal Dhooria  1 , Kuruswamy Thurai Prasad  1 , Valliappan Muthu  1 , Ashutosh Nath Aggarwal  1 , Amit Rawat  2 , Arnab Pal  3 , Amanjit Bal  4 , Mandeep Garg  5 , Arunaloke Chakrabarti  6 , Ritesh Agarwal  1
Affiliations

Sensitization to A fumigatus in subjects with non-cystic fibrosis bronchiectasis

Inderpaul Singh Sehgal et al. Mycoses. 2021 Apr.

Abstract

Background: Patients with chronic lung diseases, including cystic fibrosis (CF), are frequently sensitized to Aspergillus fumigatus. Whether patients with non-CF bronchiectasis develop sensitization to A fumigatus remains unknown.

Objective: To evaluate the prevalence of sensitization and chronic infection with A fumigatus in subjects with bronchiectasis. We also performed a multivariate logistic regression analysis to identify factors predicting sensitization and chronic A fumigatus infection.

Methods: Subjects with bronchiectasis were investigated with serum A fumigatus-specific IgE and IgG, and sputum cultures for bacteria, fungus and mycobacteria. We defined A fumigatus sensitization and chronic A fumigatus infection as serum A fumigatus-specific IgE and IgG > 0.35 kUA/L and >27 mgA/L, respectively. We excluded subjects with bronchiectasis secondary to allergic bronchopulmonary aspergillosis.

Results: We included 258 subjects (TB [n = 155], idiopathic [n = 66] and other causes [n = 37]) with bronchiectasis. The prevalence of Aspergillus sensitization, chronic Aspergillus infection, and both sensitization and chronic infection was 29.5% (76/258), 76% (196/258) and 26% (68/258), respectively. In a multivariate logistic regression analysis, TB-related bronchiectasis was an independent risk factor for Aspergillus sensitization. Chronic Aspergillus infection was predicted by the duration of symptoms and specific aetiologies (tuberculosis and idiopathic) of bronchiectasis. The growth of Aspergillus species was also frequent in the TB group compared with other causes (32% vs 2%; P < .001).

Conclusions: We found a significant occurrence of Aspergillus sensitization and chronic infection in non-CF bronchiectasis, especially in TB bronchiectasis. In addition to Aspergillus sensitization, investigations for chronic Aspergillus infection should be routinely performed in non-CF bronchiectasis, both at diagnosis and during follow-up.

Keywords: Aspergillus; bronchiectasis; fungal ball; mycobacterium.

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References

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