2420. A Cross-Sectional Survey to Measure the Prevalence of Chronic Pulmonary Aspergillosis (CPA) Complicating Pulmonary Tuberculosis in Northern Uganda
Session: Poster Abstract Session: Tuberculosis: Epidemiology and Management
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • ID Week final poster PAGE.pdf (2.3 MB)
  • Background: Chronic pulmonary aspergillosis (CPA) complicates pulmonary tuberculosis (TB). It has a 5-year mortality of up to 85%, but is treatable with itraconazole or surgery. The estimated global prevalence of CPA post-TB is 0.8-1.3 million cases. We conducted the first survey to measure the prevalence of CPA secondary to pulmonary TB.

    Methods: A cross-sectional survey of adults treated for pulmonary TB within the last 7 years in Gulu, Uganda. All underwent clinical assessment, chest X-ray and Aspergillus-specific IgG measurement by Siemens Immulite at a cut-off of 20mg/L, which has a sensitivity of 93% and a specificity of 98% for CPA diagnosis. Patients were resurveyed two years later. CT scan was performed in those with positive serology or chest X-ray signs of CPA. GeneXpert TB PCR testing was performed on those with productive cough.

    CPA was diagnosed in patients with ALL of the following; 1 – >1 month cough or haemoptysis, 2 – raised Aspergillus-specific IgG and 3 – paracavitary fibrosis, aspergilloma or progressive cavitation on imaging. Simple aspergilloma was diagnosed in asymptomatic patients with aspergilloma and positive serology.

    Results:

    400 patients were recruited between October 2012 and February 2013. 200 (50%) were HIV positive. Median age was 42 years (range 16-83). 39% of patients were female. Median CD4 count in those with HIV was 415 cells/μL (range 0-1400). 284 patients were re-surveyed between October 2014 and February 2015.

    23 (7.7%) of those resurveyed had raised Aspergillus-specific IgG levels. 12 patients (4.2%) had CPA and 1 (0.4%) simple aspergilloma. A further 3 patients had a fungal ball on CT thorax, but normal levels of Aspergillus-specific IgG. HIV co-infection had no significant impact on the frequency of CPA. Three cases of recurrent pulmonary TB were identified, none in the CPA group.

    Conclusion: CPA complicates pulmonary tuberculosis. This data suggests the predicted global prevalence is accurate. This is a significant global public health problem, which is currently neglected. The clinical and radiological presentation of CPA is often identical to recurrent TB. In the absence of access to Aspergillus-specific IgG testing most cases of CPA are probably inaccurately diagnosed as recurrent ‘smear-negative TB’ and subjected to unnecessary and potentially toxic second-line TB therapy.

    Iain Page, MBChB, MRCP (ID), DTM&H, DipHIV, PhD1,2, Sharath Hosmane, MBChB, FRCR3, Nathan Onyachi, MBChB, FRCS4, Cyprian Opira, MBChB, FRCR5, John Opwonya, BSc6, Malcolm Richardson, PhD, FRCPath7,8, Richard Sawyer, MBChB, FRCR3, Anna Sharman, MBChB, FRCR3 and David Denning, MD FRCP FIDSA9, (1)University Hospital South Manchester, UK National Aspergillosis Centre, Manchester, United Kingdom, (2)Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom, (3)University Hospital South Manchester, Manchester, United Kingdom, (4)Gulu Regional Referral Hospital, Uganda, Gulu, Uganda, (5)St. Mary's Hospital, Lacor, Uganda, Gulu, Uganda, (6)Gulu District Health Office, Gulu, Uganda, (7)Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom, (8)UK National Aspergillosis Centre & Mycology Reference Centre, Manchester, United Kingdom, (9)Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom

    Disclosures:

    I. Page, Astellas: Grant Investigator , Research grant
    Siemens: Collaborator and Recipient of donated test kits for research purposes , Research support
    Serion: Collaborator and Recipient of donated test kits for research purposes , Research support
    Dynamiker: Collaborator and Recipient of donated test kits for research purposes , Research support
    Genesis: Collaborator and Recipient of donated test kits for research purposes , Research support

    S. Hosmane, None

    N. Onyachi, None

    C. Opira, None

    J. Opwonya, None

    M. Richardson, Astellas: Consultant , Consulting fee
    Gilead: Consultant , Consulting fee
    Dynamiker: Consultant , Consulting fee
    MSD: Consultant , Consulting fee
    Pfizer: Consultant , Consulting fee
    Basilea: Consultant , Consulting fee

    R. Sawyer, None

    A. Sharman, None

    D. Denning, F2G: Shareholder , Shares
    Astellas: Consultant , Consulting fee and Speaker honorarium
    Sigma Tau: Consultant , Consulting fee
    Basilea: Consultant , Consulting fee
    Scynexis: Consultant , Consulting fee
    Cidara: Consultant , Consulting fee
    Biosergen: Consultant , Consulting fee
    Quintiles: Consultant , Consulting fee
    Pulmatrix: Consultant , Consulting fee
    Pulmocide: Consultant , Consulting fee
    Dynamiker: Speaker's Bureau , Speaker honorarium
    Gilead: Speaker's Bureau , Speaker honorarium
    Merck: Speaker's Bureau , Speaker honorarium
    Pfizer: Speaker's Bureau , Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.