Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;65(6):625-634.
doi: 10.1111/myc.13444. Epub 2022 Apr 24.

Chronic pulmonary aspergillosis in patients with active pulmonary tuberculosis with persisting symptoms in Uganda

Martha Namusobya  1 , Felix Bongomin  2 , John Mukisa  3 , William Kane Olwit  4 , Charles Batte  1 , Claudine Mukashyaka  5 , Emmanuel Mande  5 , Richard Kwizera  5 , David W Denning  6 , Joshua Rhein  7 , Shailendra Prasad  7 , Christine Sekaggya-Wiltshire  5
Affiliations

Chronic pulmonary aspergillosis in patients with active pulmonary tuberculosis with persisting symptoms in Uganda

Martha Namusobya et al. Mycoses. 2022 Jun.

Abstract

Background: The occurrence of chronic pulmonary aspergillosis (CPA) among drug sensitive pulmonary tuberculosis (PTB) patients on optimal therapy with persistent symptoms was investigated.

Methods: We consecutively enrolled participants with PTB with persistent pulmonary symptoms after 2 months of anti-TB treatment at Mulago Hospital, Kampala, Uganda, between July 2020 and June 2021. CPA was defined as a positive Aspergillus-specific IgG/IgM immunochromatographic test (ICT), a cavity with or without a fungal ball on chest X-ray (CXR), and compatible symptoms >3 months.

Results: We enrolled 162 participants (median age 30 years; IQR: 25-40), 97 (59.9%) were male, 48 (29.6%) were HIV-infected and 15 (9.3%) had prior PTB. Thirty-eight (23.4%) sputum samples grew A. niger and 13 (8.0%) A. fumigatus species complexes. Six (3.7%) participants had intracavitary fungal balls and 52 (32.1%) had cavities. Overall, 32 (19.8%) participants had CPA. CPA was associated with prior PTB (adjusted odds ratio [aOR]: 6.61, 95% CI: 1.85-23.9, p = .004), and far advanced CXR changes (aOR: 4.26, 95% CI: 1.72-10.52, p = .002). The Aspergillus IgG/IgM ICT was positive in 10 (31.3%) participants with CPA.

Conclusions: Chronic pulmonary aspergillosis may cause persistent respiratory symptoms in up to one-fifth of patients after intensive treatment for PTB. The Aspergillus IgG/IgM ICT positivity rate was very low and may not be used alone for the diagnosis of CPA in Uganda.

Keywords: Uganda; chronic pulmonary aspergillosis; persistent symptoms; pulmonary tuberculosis.

PubMed Disclaimer

Conflict of interest statement

Disclosure

There is no conflict of interest to disclose.

Figures

Figure. 1
Figure. 1. Study enrollment
Figure 2.
Figure 2.. A positive Aspergillus IgG/IgM ICT
Figure 3.
Figure 3.. A positive Aspergillus fumigatus fungal culture
Figure 4.
Figure 4.. A CXR of a CPA negative case
Thirty-six-year-old female who was enrolled with complaints of a persistent cough, fevers, nights sweats, and chest pain after 2 months of PTB therapy. She had no prior TB treatment history. She was HIV negative. CXR showed multiple bilateral cavities, extensive air space infiltrates, and fibrosis. Aspergillus LFD was negative and fungal culture showed no significant growth
Figure 5.
Figure 5.. A CXR of a confirmed CPA case.
A 43-year male who was enrolled with complaints of a persistent cough, weight loss, and nights sweats after 2 months of PTB therapy. He had previously been treated for PTB 7 years ago and cured. He was HIV positive with a CD4 count of 423 cells/microlitre and a viral load of less than 50 copies/ml. He had history of smoking (1.5 pack years), and history of alcohol abuse. CXR showed far advanced disease with left lung collapse, and right linear opacities. Aspergillus LFD was positive and fungal culture grew A. fumigatus.
See this image and copyright information in PMC

References

    1. Denning DW, Riniotis K, Dobrashian R, Sambatakou H. Chronic Cavitary and Fibrosing Pulmonary and Pleural Aspergillosis: Case Series, Proposed Nomenclature Change, and Review. Clin Infect Dis. 2003;37(s3):S265–S280. doi:10.1086/376526 - DOI - PubMed
    1. Bongomin F Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern. Chowdhary A, ed. PLOS Pathog. 2020;16(8):e1008742. doi:10.1371/journal.ppat.1008742 - DOI - PMC - PubMed
    1. Smith NL, Denning DW. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J. 2011;37(4):865–872. doi:10.1183/09031936.00054810 - DOI - PubMed
    1. Denning DW, Pleuvry A, Cole DC. Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Organ. 2011;89(12):864–872. doi:10.2471/BLT.11.089441 - DOI - PMC - PubMed
    1. Baluku JB, Nuwagira E, Bongomin F, Denning DW. Pulmonary TB and chronic pulmonary aspergillosis: clinical differences and similarities. Int J Tuberc Lung Dis. 2021;25(7):537–546. doi:10.5588/ijtld.21.0034 - DOI - PubMed