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Published on: March 9, 2018
Prevalence of Aspergillus sensitisation in pulmonary tuberculosis-related fibrocavitary disease
Setting:
Aspergillus complicates the course of healed pulmonary tuberculosis (PTB), causing aspergilloma and chronic pulmonary aspergillosis. Whether Aspergillus also causes allergic sensitisation in PTB-related fibrocavitary disease and bronchiectasis remains unknown.
Objective:
To investigate the prevalence of Aspergillus sensitisation in healed fibrocavitary PTB.
Design:
In a case-control design, consecutive symptomatic new referrals with PTB-related fibrocavitary disease underwent spirometry, Aspergillus skin test and computed tomography of the chest, determination of serum IgE levels (total and Aspergillus fumigatus-specific), serum precipitins against A. fumigatus and eosinophil count. Aspergillus sensitisation was defined as either a positive Aspergillus skin test or A. fumigatus IgE >0.35 kUA/l.
Results:
A total of 100 subjects (50 PTB-related fibrocavitary disease, 50 controls) with a mean age of 40.8 years (standard deviation [SD] 12.2) were enrolled. Aspergillus sensitisation was present in 16 (32%) cases and two (4%) controls. Fourteen cases (one control) had IgE values >1000 IU/ml, while two cases manifested eosinophilia. Aspergillus precipitins were positive in 13 cases (two controls); of these, 8 did not have Aspergillus sensitisation. The presence of airflow obstruction on spirometry was significantly associated with Aspergillus sensitisation on univariate analysis (OR 4.96, 95%CI 1.36-18.03).
Conclusions:
There is a high prevalence of Aspergillus sensitisation in PTB-related fibrocavitary disease. The clinical relevance and therapeutic implications of this finding require further investigation.
Insights
This study found a high prevalence of Aspergillus sensitization in patients with healed pulmonary tuberculosis (PTB)-related fibrocavitary disease. This sensitization was linked to airflow obstruction, suggesting a significant clinical connection requiring further research.
Area of Science:
- Pulmonology
- Infectious Diseases
- Allergy & Immunology
Background:
- Aspergillus species are known to complicate healed pulmonary tuberculosis (PTB), leading to conditions like aspergilloma and chronic pulmonary aspergillosis.
- The potential for Aspergillus to cause allergic sensitization in patients with PTB-related fibrocavitary disease and bronchiectasis has not been previously established.
Purpose of the Study:
- To determine the prevalence of Aspergillus sensitization in individuals with healed PTB-related fibrocavitary disease.
Main Methods:
- A case-control study was conducted involving 50 patients with PTB-related fibrocavitary disease and 50 controls.
- Diagnostic methods included spirometry, Aspergillus skin testing, chest computed tomography, serum IgE measurements (total and specific for Aspergillus fumigatus), serum precipitins against A. fumigatus, and eosinophil counts.
- Aspergillus sensitization was defined by a positive Aspergillus skin test or A. fumigatus-specific IgE levels exceeding 0.35 kUA/l.
Main Results:
- Aspergillus sensitization was identified in 32% of cases (16 out of 50) compared to 4% of controls (2 out of 50).
- Airflow obstruction, as indicated by spirometry, was significantly associated with Aspergillus sensitization (OR 4.96, 95% CI 1.36-18.03).
- While 13 cases had positive Aspergillus precipitins, 8 of these did not meet the criteria for sensitization.
Conclusions:
- A high prevalence of Aspergillus sensitization exists in patients with PTB-related fibrocavitary disease.
- The clinical significance and therapeutic implications of this high sensitization rate warrant further investigation.
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