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Volpe-Chaves CE, Venturini J, B Castilho S, S O Fonseca S, F Nunes T, T Cunha EA, M E Lima G, O Nunes M, P Vicentini A, V L Oliveira SM, Carvalho LR, Thompson L, P Mendes R, M M Paniago A. Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil. Mycoses 2022; 65:715-723. [PMID: 35524507 DOI: 10.1111/myc.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/18/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. INFECTION OBJECTIVES To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. PATIENTS AND METHODS A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: a) clinical evaluation; b) chest CT scan; c) sputum examination-culture for fungi and smears for direct mycology; d) detection of anti-Aspergillus fumigatus antibodies using an enzyme-linked immunosorbent assay Platelia® test; and e) anti-Aspergillus spp. antibodies were assessed via a DID test. RESULTS The global prevalence of CPA was 10.9% (95% confidence interval, 7.2-16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and hemoptysis. Cavities, pleural thickening, and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. CONCLUSIONS The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic, and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.
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Affiliation(s)
- Cláudia E Volpe-Chaves
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - James Venturini
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Suse B Castilho
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
| | - Simone S O Fonseca
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Regional Hospital of Mato Grosso do Sul, Campo Grande, Brazil
| | - Thiago F Nunes
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Eunice A T Cunha
- Central Laboratory of Mato Grosso do Sul (LACEN-MS), Campo Grande, Brazil
| | - Gláucia M E Lima
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Maína O Nunes
- Maria Aparecida Pedrossian University Hospital, Campo Grande, Brazil
| | - Adriana P Vicentini
- Mycoses Immunodiagnostic Laboratory, Immunology Section, Adolfo Lutz Institute, São Paulo, Brazil
| | - Sandra M V L Oliveira
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Lídia R Carvalho
- Institute of Biosciences, Botucatu-São Paulo State University (UNESP), Botucatu, Brazil
| | - Luis Thompson
- Department of Medicine, Infectious Diseases Unit, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Rinaldo P Mendes
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Tropical Diseases Department, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Anamaria M M Paniago
- Graduate Program in Infectious and Parasitic Diseases, School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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