Chronic Pulmonary Aspergillosis: Burden, Clinical Characteristics and Treatment Outcomes at a Large Australian Tertiary Hospital.

Nicole Gilroy,Sharon C-A Chen,Michael Jones,Peter Wu,Justin Beardsley,Olivier Despois

doi:10.3390/jof8020110

Abstract

Chronic pulmonary aspergillosis (CPA) is a fungal lung infection associated with high morbidity and mortality. Yet, it remains under-recognized worldwide, with few Australian clinical data available. This retrospective study aimed to investigate CPA at a major tertiary referral hospital in Sydney. We identified patients having International Classification of Diseases (ICD-10) codes for “aspergillosis” and/or positive respiratory microbiology samples for Aspergillus species from January 2012–December 2018 at Westmead Hospital. Eligible cases were classified using European Respiratory Society 2016 CPA guidelines. We diagnosed 28 CPA patients: median age 60 years (IQR: 57–66), with 17 (60.7%) being males. Most had chronic cavitary pulmonary aspergillosis phenotype (n = 17, 60.7%). Twenty-three patients had outcomes data returned. Nineteen (82.6%) received antifungal therapy (median duration: 10.5 months (IQR: 6.5–20.7)). Eight (34.7%) patients received <6 months of antifungals, including three (38%) deaths. Two (13%) patients receiving ≥6 months of antifungals died. Chronic obstructive pulmonary disease (COPD) (n = 9, 32.1%) was the leading predisposing factor for CPA in our cohort. This contrasts with the global picture, where prior tuberculosis generally predominates, but is similar to findings from other high-income countries. Nevertheless, further larger-scale studies are required to determine whether these results are generalizable to the wider Australian population.

Highlights

Chronic pulmonary aspergillosis (CPA) encompasses a spectrum of progressive lung disease caused by infection with Aspergillus spp., most commonly Aspergillus fumigatus complex
Given our hospital catchment area has a higher-than-average prevalence of tuberculosis relative to the rest of Sydney, we hypothesized that this would be the leading predisposing factor for CPA patients presenting to our hospital
chronic obstructive pulmonary disease (COPD) was found to be the most common predisposing factor among our patients. It is uncertain whether this observation is truly reflective of the wider Australian CPA population or if this is due to an incomplete capture of the CPA population in the area as a result of only searching inpatient admissions

Summary

Introduction

Chronic pulmonary aspergillosis (CPA) encompasses a spectrum of progressive lung disease caused by infection with Aspergillus spp., most commonly Aspergillus fumigatus complex. It generally occurs in individuals with pre-existing structural lung defects or relatively minor immunosuppression secondary to comorbid disease [1,2]. Prior pulmonary tuberculosis (TB) is the leading risk factor for developing CPA worldwide, chronic obstructive pulmonary disease (COPD). CPA comprises five clinical phenotypes: chronic cavitary pulmonary aspergillosis (CCPA), subacute invasive aspergillosis (SAIA; formerly chronic necrotizing pulmonary aspergillosis (CNPA)), chronic fibrosing pulmonary aspergillosis (CFPA), Aspergillus nodule and simple aspergilloma, distinguished by radiological and clinical features [1]. The phenotype and severity of CPA is determined by dynamics of host–pathogen interactions [4]

Methods

Discussion

Conclusion