在塞拉利昂的一家城市三级医院中，曲霉菌血清阳性和慢性肺曲霉病的流行情况及预测因素：一项横断面研究。
Prevalence and predictors of Aspergillus seropositivity and chronic pulmonary aspergillosis in an urban tertiary hospital in Sierra Leone: A cross-sectional study.
机构信息
College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
出版信息
PLoS Negl Trop Dis. 2023 Jul 17;17(7):e0011284. doi: 10.1371/journal.pntd.0011284. eCollection 2023 Jul.
BACKGROUND
In the World Health Organization Global Tuberculosis (TB) Report 2022, 37% of pulmonary TB patients were clinically diagnosed and thus many people were treated for TB without evidence of the disease. Probably the most common TB misdiagnosis is chronic pulmonary aspergillosis (CPA). In this study, we aimed to assess the prevalence and predictors of Aspergillus seropositivity and CPA in patients with chronic respiratory symptoms in an urban tertiary hospital in Sierra Leone.
METHODOLOGY/PRINCIPAL FINDINGS: We used a cross-sectional study design to recruit adults (≥18 years) from the Chest Clinic of Connaught Hospital, Freetown between November 2021 and July 2022. Aspergillus antibody was detected using LDBio Aspergillus IgM/IgG. Logistic regression was performed to assess the independent predictors of Aspergillus seropositivity and CPA. Of the 197 patients with chronic respiratory symptoms, 147 (74.6%) were male. Mean age was 47.1 ± 16.4 years. More than half (104, 52.8%) had been diagnosed with TB in the past, while 53 (26.9%) were on TB treatment at the time of recruitment. Fifty-two (26.4%) patients were HIV positive, 41 (20.8%) were seropositive for Aspergillus and 23 (11.6%) had CPA, 2 (3.8%) with current TB and 18 (17.3%) with past TB. Common radiologic abnormalities reported were localized fibrotic changes 62 (31.5%), consolidation 54 (27.4%), infiltrates 46 (23.4%), hilar adenopathy 40 (20.3%) and pleural effusion 35 (17.85) and thickening 23 (11.7%). Common symptoms were weight loss 144 (73.1%), cough 135 (68.5%), fever 117 (59.4%) and dyspnea 90 (45.7%). Current or past TB infection {aOR 3.52, 95% CI (1.46, 8.97); p = 0.005} was an independent predictor of Aspergillus seropositivity and CPA.
CONCLUSIONS/SIGNIFICANCE: We report a high prevalence of Aspergillus antibody seropositivity and CPA, underscoring the need to integrate the prevention and management of pulmonary fungal infections with TB services and asthma care in order to reduce unnecessary morbidity and mortality.
背景
在 2022 年世界卫生组织全球结核病报告中，37%的肺结核患者是临床诊断的，因此许多人在没有结核病证据的情况下接受了结核病治疗。最常见的结核病误诊可能是慢性肺部曲霉病（CPA）。在这项研究中，我们旨在评估塞拉利昂一家市级三级医院慢性呼吸道症状患者中曲霉菌血清阳性和 CPA 的患病率和预测因素。
方法/主要发现：我们使用横断面研究设计，于 2021 年 11 月至 2022 年 7 月期间从弗里敦康诺特医院胸科诊所招募成年人（≥18 岁）。使用 LDBio 曲霉 IgM/IgG 检测曲霉抗体。使用逻辑回归评估曲霉菌血清阳性和 CPA 的独立预测因素。在 197 例有慢性呼吸道症状的患者中，147 例（74.6%）为男性。平均年龄为 47.1 ± 16.4 岁。过去一半以上（104 例，52.8%）被诊断患有结核病，而 53 例（26.9%）在招募时正在接受结核病治疗。52 例（26.4%）患者 HIV 阳性，41 例（20.8%）曲霉菌血清阳性，23 例（11.6%）患有 CPA，2 例（3.8%）为现患结核病，18 例（17.3%）为既往结核病。报告的常见放射学异常为局灶性纤维化改变 62 例（31.5%）、实变 54 例（27.4%）、浸润 46 例（23.4%）、肺门淋巴结肿大 40 例（20.3%）和胸腔积液 35 例（17.85%）和胸膜增厚 23 例（11.7%）。常见症状为体重减轻 144 例（73.1%）、咳嗽 135 例（68.5%）、发热 117 例（59.4%）和呼吸困难 90 例（45.7%）。当前或既往结核病感染[aOR 3.52，95%CI（1.46，8.97）；p=0.005]是曲霉菌血清阳性和 CPA 的独立预测因素。
结论/意义：我们报告了曲霉菌抗体血清阳性和 CPA 的高患病率，这突出表明需要将肺部真菌感染的预防和管理与结核病服务和哮喘护理相结合，以减少不必要的发病率和死亡率。
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