Allergic Bronchopulmonary Aspergillosis in Patients With Prior Pulmonary Tuberculosis: A Study on the Burden, Clinic-Radiological Features, Treatment Outcomes and Comparison With Chronic Pulmonary Aspergillosis and Post-Tubercular Lung Disease Patients.

IF 4.1 2区医学 Q1 DERMATOLOGY

Mycoses Pub Date : 2025-02-01 DOI:10.1111/myc.70034

Anuj Ajayababu, Ved Prakash Meena, Prayas Sethi, Amandeep Singh, Ranveer Singh Jadon, Gagandeep Singh, Immaculata Xess, Stanzin Spalkit, Neeraj Nischal, Surabhi Vyas, Sanjeev Sinha, Naveet Wig, Animesh Ray

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Abstract

Background: Post-tuberculosis lung disease (PTLD) is a precursor to Aspergillus-related lung diseases. While Chronic Pulmonary Aspergillosis (CPA) has been extensively studied in the background of tuberculosis, Allergic Bronchopulmonary Aspergillosis (ABPA) has been reported sporadically with limited information on its prevalence, clinical-radiological features, and treatment outcomes.

Objective: This study, conducted in a high TB burden setting, aimed to address this knowledge gap by systematically evaluating ABPA in PTLD patients.

Methods: This retrospective cohort study screened PTLD patients presenting with respiratory or constitutional symptoms persisting for more than 3 months. The objective was to report the prevalence, clinical-radiological-laboratory data, and outcomes of ABPA-PTLD compared to a cohort of CPA (CPA-PTLD) and patients with PTLD (PTLD only).

Results: Out of a total of 1012 PTLD patients, ABPA was seen in 2.27%, CPA in 20.75% and Aspergillus sensitization in 0.7%. ABPA patients primarily presented with breathlessness (91.3%) and cough (82.6%) while haemoptysis (43.5%), weight loss (13%), and anorexia (21.7%) were also observed, albeit less commonly than in CPA-PTLD. Bronchiectasis (100%) and nodules (87%) were more frequent in ABPA-PTLD patients, whereas consolidation (21.7%), cavities (30.4%), pleural thickening (8.7%), and 'fungal ball' (9.1%) were also seen, although less commonly than in CPA-PTLD. Most patients received azoles (78%) as first-line therapy, with symptomatic improvement (partial/complete) observed in ~78%.

Conclusion: ABPA may occur in PTLD patients, with specific clinical (e.g., haemoptysis) and radiological (e.g., cavity and fungal ball) features uncommon in other types of ABPA, but resembling other PTLD conditions. Future studies should focus on identifying differences in the natural course and appropriate treatment paradigms of ABPA-PTLD patients compared to ABPA occurring in asthma and cystic fibrosis patients.

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既往肺结核患者变应性支气管肺曲霉病：慢性肺曲霉病与结核后肺病患者负担、临床影像学特征、治疗效果及比较研究

背景：结核后肺病（PTLD）是曲霉相关肺病的前兆。慢性肺曲霉病（CPA）已在结核病背景下进行了广泛的研究，而过敏性支气管肺曲霉病（ABPA）已被零星报道，但有关其患病率、临床放射学特征和治疗结果的信息有限。目的：本研究在高结核病负担环境中进行，旨在通过系统评估PTLD患者的ABPA来解决这一知识差距。方法：本回顾性队列研究筛选呼吸道或体质症状持续3个月以上的PTLD患者。目的是报告ABPA-PTLD的患病率，临床-放射-实验室数据，以及与CPA （CPA-PTLD）和PTLD患者（仅PTLD）进行比较的结果。结果：在1012例PTLD患者中，ABPA发生率为2.27%，CPA发生率为20.75%，曲霉致敏率为0.7%。ABPA患者主要表现为呼吸困难（91.3%）和咳嗽（82.6%），同时还观察到咯血（43.5%）、体重减轻（13%）和厌食（21.7%），尽管比CPA-PTLD患者少。支气管扩张（100%）和结节（87%）在ABPA-PTLD患者中更为常见，而实变（21.7%）、空腔（30.4%）、胸膜增厚（8.7%）和“真菌球”（9.1%）也可见，尽管比ppa - ptld少见。大多数患者（78%）接受唑类药物作为一线治疗，约78%的患者观察到症状改善（部分/完全）。结论：ABPA可能发生在PTLD患者中，具有其他类型ABPA不常见的特定临床（如咯血）和影像学（如腔和真菌球）特征，但与其他PTLD相似。未来的研究应侧重于确定ABPA- ptld患者与哮喘和囊性纤维化患者发生的ABPA的自然病程和适当治疗模式的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.