Chronic pulmonary aspergillosis in patients with bronchiectasis
State University of Medicine and Pharmacy “ Nicolae Testemitanu”

Department of Internal medicine, Pneumology and allergology
Munteanu O., Botnaru V., Volosciuc I., Scutaru E.
Background and aim
Aspergillus-related diseases can complicate patients with already established bronchiectasis and lung architectural disruption, for example, an aspergilloma in a patient with post-tuberculosis bronchiectasis. Furthermore, other coexistent diseases such as chronic obstructive pulmonary disease or bronchial asthma can increase the risk of Aspergillus-related disease but also independently can be associated with bronchiectasis. 
To evaluate the prevalence, clinical and radiological characteristics of chronic pulmonary aspergillosis (CPA) in patients with bronchiectasis. 
Methods
All patients referred to the Moldovan National Bronchiectasis Centre with bronchiectasis between Dec 2009 and Dec 2017 were screened for CPA by HRCT, culture results and serum anti-Aspergillus IgG. 
Results
Of 334 referred patients with bronchiectasis, post-tuberculosis bronchiectasis identified in 88 cases (26%). A total of 14 CPA patients, which included 10 (71%) males, had a median age of 55.7 ±14. Four patients had a history of treated pulmonary tuberculosis, but calcifications as a possible imaging marker of “spontaneous recovery” were identified in 12 patients (86%). Asthma was present from childhood in 2 cases that developed ABPA, one of them was treated for pulmonary tuberculosis (4 episodes). The median interval between ABPA and onset of CPA was 5 years.  Other underlying lung conditions included chronic obstructive pulmonary disease (n = 6; 42%) and previous thoracic surgery (n = 1). All patients presented with chronic pulmonary or systemic symptoms, such as purulent sputum (100%), cough (100%), haemoptysis (n = 10, 71%) and weight loss (n = 11, 78%). The most common location of cavitary lesions (figure 1) was the right lung (n = 8, 57%). Death occurred in 2 patients (14%).  
     
Conclusion
Post-tuberculosis bronchiectasis is a common sequela in a high burden TB country and coexistent CPA may arise and should be considered, especially in smear negative patients suspected for TB reactivation.