Objectives:
 
The incidence of chronic pulmonary aspergillosis (CPA) is getting high especially in high tuberculosis (TB) burden countries. However there is limited data available on CPA as a post-TB sequel and in structural lung diseases. The aim of the study is to determine the clinical characteristics and outcomes of patients with CPA in a tertiary care hospital.


Methods:
This is a retrospective study in patients admitted with pulmonary Aspergillosis at the Aga Khan University Hospital (AKUH), Karachi, Pakistan from January 2012 to December 2016. All adult patients (> 18 years) admitted with a diagnosis of Aspergillosis using International Classification of Disease, Ninth Revision codes (ICD-9 1173) were identified. Data on demographics, comorbid conditions, underlying lung condition, radiographic and microbiological findings, requirement of invasive and non-invasive mechanical ventilation (NIMV), respiratory complications and in hospital mortality was collected on a predesigned form.
CPA was defined as one or more cavities with or without a fungal ball or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) and exclusion of alternative diagnoses, all present for at least 3 months


Results:
A total of 47 patients were included, who met the inclusion criteria. Majorities were male 36(76.59%) and diabetic 14(29.78%).Mean age was 45 ± 15.7 years. The Commonest form of CPA was Simple Aspergilloma 23(48.93%) followed by Chronic cavitory pulmonary aspergillosis (CCPA) 20(42.55%),Chronic progressive pulmonary fibrosis (CPFA) 2(4.2%) and nodule 2(4.2%). The commonest underlying cause was post tuberculosis 33(70.21%) followed by bronchiectasis 14(29.78%), asthma with allergic bronchopulmonary aspergillosis (ABPA) and cardiothoracic surgery in 5(10.63%) each. Sputum culture was positive in 22(46.8%) and the commonest Aspergillus species identified was Aspergillus fumigatus 7(31.8%), flavus 7(31.8%) followed by niger 6(27.2%) and terrus 3(13.6%).Surgical excision was done in 23(48.93%) while itraconzole received by 31(65.95%) patients. Out of 47, three patients died due to chronic respiratory failure.



Conclusion:
Currently the burden of CPA is raising especially in high TB burden countries like Pakistan. We found Aspergilloma and CCPA as the commonest form of CPA. Further large prospective studies using Aspergillus specific IgG antibodies testing are required for better understanding of prevalence of CPA.

4 / Clinical features and outcome of Chronic Pulmonary Aspergillosis: experience from a high tuberculosis burden country