Chronic Pulmonary Aspergillosis in Patients with Non-Tuberculous Mycobacterial Disease
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Authors
Smallcombe N.
Kabalan L.
Malhotra A.
Chen C.
Joseph S.
Boza K.
Bamford R.
Natarajan S.
Kunst,H.
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Issue Date
2024
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Conference Proceedings
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Introduction Chronic pulmonary aspergillosis (CPA) can be a complication of non-tuberculous mycobacteria pulmonary disease (NTM-PD). In this context, CPA is often difficult to diagnose as both CPA and NTM-PD present with similar symptoms and chronic cavitatory changes on cross-sectional imaging. Identification of CPA is however crucial given high rates of morbidity and mortality with concurrent infection. Methods We conducted a retrospective study of consecutive NTM-PD patients identified at our trust between 2016 and 2024. NTM-PD was defined as per American Thoracic Society guidelines (clinical, radiological and microbiological criteria - two or more positive and consistent sputum isolates, a bronchoalveolar lavage sample or biopsy). Clinical information including aspergillus serology and microbiological data was extracted from patient electronic health records. Results Eighty-four patients with NTM-PD were identified. Of these, 43 (51%) were female. The median age was 66 years (IQR 23). Thirty-six (43%) patients had a background of bronchiectasis, 27 (32%) patients had COPD, seven (8%) patients had both COPD and bronchiectasis, and 14 (17%) patients had no underlying lung disease. Fourty-eight (57%) patients had Mycobacterium avium complex (MAC), 13 Mycobacterium abscessus(15%) 13 Mycobacterium kansasii (15%). Ten (12%) patients isolated other mycobacterial species including Mycobacterium Szulgai and Mycobacteria Europeam. Sixteen (19%) patients had an elevated aspergillus-specific IgG greater than 75mg/L. Ten were not commenced on antifungal treatment, one was considered for treatment but passed away prior to commencement. Of the five that were commenced on treatment all received Triazoles Itraconazole, Voriconazole, Posaconazole] and two received Amphotericin B. Nine (11%) patients had direct evidence of aspergillus infection on sputum, bronchoalveolar lavage culture or on biopsy. Conclusion CPA should be considered when NTM-PD patients present with progression of symptoms and/or radiological changes despite appropriate treatment for their NTM-PD. Serial aspergillus serology and fungal cultures aids diagnosis.
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Thorax