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. 2021 Jul;64(7):788-793.
doi: 10.1111/myc.13284. Epub 2021 Apr 24.

A simple x-ray scoring system for the diagnosis of chronic pulmonary aspergillosis

Priya Ramachandran  1 , Jayanthi Savio  2 , Priyadarshini Padaki  2 , Ruchita Chhabra  2 , Chitra Veluthat  1 , Uma Devaraj  1 , Kavitha Venkatanarayan  1 , Uma M Krishnaswamy  1 , Santu Ghosh  3 , George A D'souza  1
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A simple x-ray scoring system for the diagnosis of chronic pulmonary aspergillosis

Priya Ramachandran et al. Mycoses. 2021 Jul.

Abstract

Background: Chronic pulmonary aspergillosis (CPA) is a severe form of post-tuberculosis lung disease (PTBLD). Considering the high burden of TB in India, it can be concluded that the prevalence of CPA is also high. Chest x-ray though most feasible, interpretation is subjective. Therefore, decision on evaluation for CPA cannot be based on x-ray alone.

Objective: Present study evaluated an x-ray score as a marker for extent of lung damage in patients with PTBLD presenting with haemoptysis and its utility to predict Aspergillus serum IgG levels.

Methods: We used a modified scoring system developed by Anna Ralph et al X-ray score cut-offs of >71 and 40, with or without history of massive haemoptysis, were compared with serum IgG levels.

Results: With a chest x-ray score cut-off of 71, specificity was 88%. With an x-ray score of >71 combined with history of massive haemoptysis, 86% cases were found to be IgG positive. The specificity of this combination was 96%.

Conclusion: This study concluded that a simple chest x-ray scoring system in addition to the symptom of massive haemoptysis helped in the decision on further evaluation of the subject for CPA, especially in resource constrained settings.

Keywords: Aspergillus IgG; CPA; PTB; PTBLD; chronic pulmonary aspergillosis; haemoptysis; scoring; x-ray.

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