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Chronic Pulmonary Aspergillosis Following Nontuberculous Mycobacterial Infections: An Emerging Disease

Pakpoom Phoompoung1, Methee Chayakulkeeree1

  • 1Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.

Journal of Fungi (Basel, Switzerland)
|December 11, 2020
PubMed

Insights

Chronic pulmonary aspergillosis (CPA) after nontuberculous mycobacterial (NTM) lung disease is rising. NTM lung disease predicts mortality in CPA, with diagnosis aided by serology and treatment complicated by drug interactions.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Mycology

Background:

  • Chronic pulmonary aspergillosis (CPA) following nontuberculous mycobacterial (NTM) lung disease is increasingly recognized.
  • NTM lung disease is a predictor of mortality in CPA patients.

Purpose of the Study:

  • To review the incidence, risk factors, diagnosis, treatment challenges, and prognosis of NTM-associated CPA.

Main Methods:

  • Literature review of studies on NTM-associated CPA.
  • Analysis of diagnostic methods, including serological tests versus fungal culture.
  • Evaluation of treatment guidelines and prognostic factors.

Main Results:

  • Incidence of NTM-associated CPA ranges from 3.9-16.7%.
  • Risk factors include fibrocavitary NTM disease, emphysema, and high-dose corticosteroids.
  • Serological diagnosis shows higher sensitivity and specificity than fungal culture.
  • Treatment is challenging due to drug interactions (e.g., rifampicin and oral triazoles).
  • Poor prognosis is associated with corticosteroid use and elevated C-reactive protein levels.

Conclusions:

  • NTM lung disease is a significant risk factor for CPA with a poor prognosis.
  • Early diagnosis and careful treatment strategies are crucial for managing NTM-associated CPA.
Keywords:
Aspergillusaspergillosisfungal infectionnon-tuberculous mycobacteriapulmonary infection

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