Soeroso Noni N, Siahaan Lambok, Khairunnisa Selfi, Anggriani Raden Ajeng Henny, Aida Aida, Eyanoer Putri C, Daulay Elvita R, Burhan Erlina, Rozaliyani Anna, Ronny Ronny, Adawiyah Robiatul, Denning David W, Wahyuningsih Retno
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Universitas Sumatera Utara Hospital, Medan 20155, Indonesia.
Department of Parasitology, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia.
J Fungi (Basel). 2024 Jul 29;10(8):529. doi: 10.3390/jof10080529.
In Indonesia, 2.4% of all new tuberculosis patients had multi-drug resistant disease (MDR-TB); an estimated 24,000 incidences. Historical case series of MDR-TB described a high frequency of cavitation and poor prognosis. The diagnosis of chronic pulmonary aspergillosis (CPA) relies on raised levels of IgG antibodies, and detectable IgG antibodies are suspicious for chronic pulmonary histoplasmosis (CPH). We investigated whether MDR-TB patients might have concurrent CPH or CPA. This was a cross-sectional study with 50 MDR-TB patients. ELISA was used to detect IgG antibodies and lateral flow assay was used to detect IgG/IgM antibodies. Several other possible disease determinants were assessed by multivariate analysis. Of the 50 MDR-TB patients, 14 (28%) and 16 (32%) had positive or serology; six patients (12%) had dual antibody reactivity. Radiological abnormalities in positive patients included diffuse or local infiltrates, nodules, consolidation, and apical cavities, consistent with CPH and CPA. Patients with detectable fungal antibodies tended to have worse disease, and 4 of 26 (15.3%) died in the first 5 months of dual infection ( = 0.11 compared with no deaths in those with only MDR-TB). The criteria for the diagnosis of CPH and CPA were fulfilled in those with moderately and far advanced disease (13 of 14 or 93%) and 12 of 16 (75%), respectively. Damp housing was the only determinant associated with antibodies (PR 2.01; 95%CI 0.56-7.19), while pets were associated with the antibody (PR 18.024; 95%CI 1.594-203.744). CPA or CPH are probably frequent in MDR-TB patients in Indonesia and may carry a worse prognosis.
在印度尼西亚，所有新发结核病患者中有2.4%患有耐多药疾病（耐多药结核病）；估计有24000例发病。耐多药结核病的历史病例系列描述了空洞形成的高频率和不良预后。慢性肺曲霉病（CPA）的诊断依赖于IgG抗体水平升高，可检测到的IgG抗体对慢性肺组织胞浆菌病（CPH）具有可疑性。我们调查了耐多药结核病患者是否可能并发CPH或CPA。这是一项对50例耐多药结核病患者的横断面研究。采用酶联免疫吸附测定（ELISA）检测IgG抗体，采用侧向流动分析法检测IgG/IgM抗体。通过多变量分析评估了其他几个可能的疾病决定因素。在50例耐多药结核病患者中，14例（28%）和16例（32%）的或血清学检测呈阳性；6例患者（12%）具有双重抗体反应性。阳性患者的放射学异常包括弥漫性或局灶性浸润、结节、实变和肺尖空洞，与CPH和CPA一致。可检测到真菌抗体的患者病情往往更严重，26例中有4例（15.3%）在双重感染的前5个月死亡（与仅患有耐多药结核病的患者无死亡相比，P = 0.11）。中度和晚期疾病患者分别有13例（14例中的93%）和12例（16例中的75%）符合CPH和CPA的诊断标准。潮湿的住房是与抗体相关的唯一决定因素（风险比2.01；95%置信区间0.56 - 7.19），而宠物与抗体相关（风险比18.024；95%置信区间1.594 - 203.744）。在印度尼西亚，CPA或CPH在耐多药结核病患者中可能很常见，并且可能预后更差。
