Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
National Aspergillosis Centre, ECMM Excellence Centre of Medical Mycology, Manchester University NHS Foundation Trust, Manchester, UK.
Eur Respir J. 2019 Mar 18;53(3). doi: 10.1183/13993003.01184-2018. Print 2019 Mar.
Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography and -specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raised specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%, 95% CI 2.8-7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26% 0.8%; p<0.001), but possibly less frequent in HIV co-infected patients (3% 6.7%; p=0.177 The annual rate of new CPA development between surveys was 6.5% in those with chest radiography cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening on chest radiography had 100% negative predictive value for CPA. The combination of raised specific IgG, chronic cough or haemoptysis and chest radiography cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis.CPA commonly complicates treated pulmonary TB with residual chest radiography cavitation. Chest radiography alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.
慢性肺曲霉病（CPA）并发治疗后的肺结核（TB），5 年死亡率较高。我们在这组人群中测量了 CPA 的患病率。398 名患有治疗后肺结核的乌干达人接受了临床评估、胸部 X 光检查和特异性 IgG 测量。285 人在 2 年后再次接受调查，其中 73 人疑似 CPA 接受了胸部计算机断层扫描。在没有活动性 TB、特异性 IgG 升高、CPA 的放射学特征和慢性咳嗽或咯血的患者中诊断为 CPA。在 14 名（4.9%，95%CI 2.8-7.9%）再次调查的患者中存在作者定义的 CPA。胸部 X 光检查有空洞的患者（26% 0.8%；p<0.001）CPA 更为常见，但 HIV 合并感染患者（3% 6.7%；p=0.177）可能较少。在胸部 X 光检查有空洞的患者中，CPA 新发病例的年发生率为 6.5%，在没有空洞的患者中为 0.2%（p<0.001）。胸部 X 光检查无空洞和胸膜增厚对 CPA 的阴性预测值为 100%。特异性 IgG 升高、慢性咳嗽或咯血和胸部 X 光检查有空洞的组合对 CPA 的诊断具有 85.7%的敏感性和 99.6%的特异性。CPA 常见于治疗后肺结核合并残留胸部 X 光检查有空洞的患者。单独的胸部 X 光检查可以排除 CPA。添加血清学检查可以以合理的准确性诊断 CPA。
