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Updated: Jan 30, 2026
Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
Published on: April 9, 2012
Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation
Iain D Page1,2, Rosemary Byanyima3, Sharath Hosmane4
1Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK iain.page@manchester.ac.uk.
Abstract:
Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography and Aspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raised Aspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%, 95% CI 2.8-7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26% versus 0.8%; p<0.001), but possibly less frequent in HIV co-infected patients (3% versus 6.7%; p=0.177) The annual rate of new CPA development between surveys was 6.5% in those with chest radiography cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening on chest radiography had 100% negative predictive value for CPA. The combination of raised Aspergillus-specific IgG, chronic cough or haemoptysis and chest radiography cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis.CPA commonly complicates treated pulmonary TB with residual chest radiography cavitation. Chest radiography alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.
Insights
Chronic pulmonary aspergillosis (CPA) frequently complicates treated pulmonary tuberculosis (TB). Residual cavitation on chest X-rays strongly predicts CPA development, which can be diagnosed with serology and imaging.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Chronic pulmonary aspergillosis (CPA) is a serious complication following treated pulmonary tuberculosis (TB), associated with high mortality.
- Understanding CPA prevalence in TB survivors is crucial for effective management and improved outcomes.
Purpose of the Study:
- To determine the prevalence of CPA in Ugandan patients who have completed TB treatment.
- To identify risk factors and diagnostic markers for CPA in this population.
Main Methods:
- A cohort of 398 Ugandan patients with treated pulmonary TB were assessed clinically, with chest radiography and Aspergillus-specific IgG measurement.
- 285 patients were resurveyed after 2 years, with CT scans for 73 individuals suspected of having CPA.
- CPA diagnosis required absence of active TB, elevated Aspergillus-specific IgG, characteristic radiological findings, and chronic symptoms.
Main Results:
- CPA was diagnosed in 4.9% of patients at the 2-year resurvey.
- CPA was significantly more common in patients with cavitation on chest radiography (26% vs 0.8%).
- Absence of cavitation and pleural thickening on chest X-ray had 100% negative predictive value for CPA.
Conclusions:
- CPA commonly complicates treated pulmonary TB, particularly in individuals with residual cavitation on chest radiography.
- Chest radiography is valuable for excluding CPA, while its combination with serology aids in diagnosis.
- Early diagnosis and management of CPA in TB survivors are essential to reduce mortality.
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