A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL).

Autor:	Setianingrum F; Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.; Pulmonary Mycosis Centre, Jakarta, Indonesia., Rozaliyani A; Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Pulmonary Mycosis Centre, Jakarta, Indonesia.; Grha Permata Ibu Hospital, Jakarta, Indonesia.; MH Thamrin Hospital, Jakarta, Indonesia., Adawiyah R; Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Pulmonary Mycosis Centre, Jakarta, Indonesia., Syam R; Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Pulmonary Mycosis Centre, Jakarta, Indonesia., Tugiran M; Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Pulmonary Mycosis Centre, Jakarta, Indonesia., Sari CYI; Jakarta Islamic Hospital, Cempaka Putih, Jakarta, Indonesia., Nandipinto F; Pulmonary Mycosis Centre, Jakarta, Indonesia., Ramnath J; Department of Internal Medicine, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia.; Universitas Kristen Indonesia Hospital, Jakarta, Indonesia., Arifin AR; Pulmonary Mycosis Centre, Jakarta, Indonesia.; MH Thamrin Hospital, Jakarta, Indonesia., Handayani D; Pulmonary Mycosis Centre, Jakarta, Indonesia.; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia., Burhan E; Pulmonary Mycosis Centre, Jakarta, Indonesia.; Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia., Rumende M; Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Dr Ciptomangunkusumo Hospital, Jakarta, Indonesia., Wahyuningsih R; Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.; Pulmonary Mycosis Centre, Jakarta, Indonesia.; Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia., Rautemaa-Richardson R; Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.; National Aspergillosis Centre and the Department of Infectious Diseases, Manchester University NHS Foundation Trust, Manchester, UK., Denning DW; Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK ddenning@manchester.ac.uk.; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2022 Aug; Vol. 77 (8), pp. 821-828. Date of Electronic Publication: 2021 Nov 30.
DOI:	10.1136/thoraxjnl-2020-216464
Abstrakt:	Objectives: Chronic pulmonary aspergillosis (CPA) can complicate recovery from pulmonary TB. CPA may also be misdiagnosed as bacteriologically negative TB. This study aimed to determine the incidence of CPA in patients treated for TB in Indonesia, a country with a high incidence of TB. Methods: In this prospective, longitudinal cohort study in patients treated for pulmonary TB, clinical, radiological and laboratory findings were analysed. Sputum was collected for fungal culture and TB PCR. Patients were assessed at baseline (0-8 weeks) and at the end (5-6 months) of TB therapy. CPA diagnosis was based on symptoms (≥3 months), characteristic radiological features and positive Aspergillus serology, and categorised as proven, probable and possible. Results: Of the 216 patients recruited, 128 (59%) were followed up until end of TB therapy. At baseline, 91 (42%) had microbiological evidence for TB. Aspergillus -specific IgG was positive in 64 (30%) patients and went from negative to positive in 16 (13%) patients during TB therapy. The incidence rates of proven and probable CPA at baseline were 6% (n=12) and 2% (n=5) and end of TB therapy 8% (n=10) and 5% (n=7), respectively. Six patients (two with confirmed TB) developed an aspergilloma. Diabetes mellitus was a significant risk factor for CPA (p=0.040). Persistent cough (n=5, 50%; p=0.005) and fatigue (n=6, 60%; p=0.001) were the most common symptoms in CPA. Conclusion: CPA should be considered a relatively frequent differential diagnosis in patients with possible or proven TB in Indonesia. Lack of awareness and limited access to Aspergillus -specific IgG tests and CT imaging are obstacles in establishing a CPA diagnosis. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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