Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, UK.
Department of Bacteriology, Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, GA-337, Ghana.
Med Mycol. 2022 Sep 9;60(9). doi: 10.1093/mmy/myac063.
Chronic pulmonary aspergillosis (CPA) may mimic pulmonary tuberculosis (PTB). The two diseases are clinically indistinguishable and may result in CPA misdiagnosed as PTB or vice versa. Although PTB is largely recognised as a differential diagnosis of CPA and often ruled out prior to CPA diagnosis, the reverse is uncommon. The aim of this study was to determine the proportion of CPA cases among patients being assessed for PTB. A cross-sectional survey was conducted among consecutive patients referred for GeneXpert Mycobacterium tuberculosis test for the diagnosis of PTB at the Korle-Bu Teaching Hospital, Accra, Ghana. Patients' demographics, clinical and socioeconomic details were obtained using a structured questionnaire. Blood was collected for Aspergillus and HIV serology, and sputum samples obtained for Aspergillus culture. Chest radiograph was obtained, and computed tomography scan was also done for patients with positive Aspergillus serology or cavitation. CPA was defined using an algorithm developed by the Global Action for Fungal Infections (GAFFI) international expert panel. A total of 154 patients were included in the analysis, of whom 134 (87%) did not have a prior PTB diagnosis. There were 41 (26.6%) GeneXpert positive cases. CPA prevalence was 9.7% overall, but 50% in patients with a prior history of PTB and 3.7% in those without previous PTB. Although CPA is rarely considered as a differential diagnosis of PTB in Ghana, our findings show that CPA may affect half of patients being assessed for PTB relapse. Efforts to diagnose CPA should be prioritised in this patient group.
慢性肺曲霉病（CPA）可能类似于肺结核（PTB）。这两种疾病在临床上难以区分，可能导致 CPA 误诊为 PTB，反之亦然。虽然 PTB 通常被认为是 CPA 的鉴别诊断，并且在 CPA 诊断之前通常会排除在外，但反之则很少见。本研究旨在确定在评估 PTB 的患者中 CPA 病例的比例。在加纳科托卡教学医院，对连续转诊进行 GeneXpert 结核分枝杆菌检测以诊断 PTB 的患者进行了横断面调查。使用结构化问卷获得患者的人口统计学、临床和社会经济详细信息。采集血液进行曲霉和 HIV 血清学检测，并获得痰液样本进行曲霉培养。进行了胸部 X 光检查，对曲霉血清学或空洞阳性的患者还进行了计算机断层扫描。根据全球真菌感染行动（GAFFI）国际专家小组制定的算法定义了 CPA。共纳入了 154 名患者进行分析，其中 134 名（87%）没有 PTB 既往诊断。有 41 名（26.6%）GeneXpert 阳性病例。总体而言，CPA 的患病率为 9.7%，但既往有 PTB 病史的患者中为 50%，无既往 PTB 病史的患者中为 3.7%。虽然在加纳，CPA 很少被认为是 PTB 的鉴别诊断，但我们的研究结果表明，CPA 可能影响一半正在评估 PTB 复发的患者。应优先在这组患者中诊断 CPA。
