Pathology

Tuberculosis

Pulmonary aspergillosis

Intensive care medicine

Aspergillosis

Immunology

Pulmonary tuberculosis

Medicine

European Respiratory Journal

Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group. 398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography and Aspergillus -specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raised Aspergillus- specific IgG, radiological features of CPA and chronic cough or haemoptysis. Author-defined CPA was present in 14 (4.9%, 95% CI 2.8–7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26% versus 0.8%; p&lt;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 radiography cavitation and 0.2% in those without (p&lt;0.001). Absence of cavitation and pleural thickening on chest radiography had 100% negative predictive value for CPA. The combination of raised Aspergillus- specific IgG, chronic cough or haemoptysis and chest radiography cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis. CPA commonly complicates treated pulmonary TB with residual chest radiography cavitation. Chest radiography alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.

Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation