Abstract
Chronic pulmonary aspergillosis (CPA) following nontuberculous mycobacterial (NTM) lung disease is being increasingly recognized, especially in countries where tuberculosis is not endemic, with an incidence rate of 3.9–16.7%. NTM lung disease has been identified as a predictor of mortality in CPA patients. The major risk factors for NTM-associated CPA include fibrocavitary NTM lung disease, the presence of pulmonary emphysema, and high-dose corticosteroid use. The onset of CPA is 1.5–7 years following the diagnosis of NTM lung disease. The diagnosis can be made using standard criteria; however, serological diagnosis using Aspergillus precipitin has demonstrated a higher sensitivity and specificity when compared with fungal culture from respiratory specimens. Treatment is challenging since rifampicin and oral triazoles should not be used concomitantly. The prognosis is poor, and the factors associated with worse prognosis are corticosteroid use and high C-reactive protein level.
Highlights
Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary infection that is caused by Aspergillus species, and which results in destruction of lung parenchyma [1]
Since novel regimens without rifampicin have been used successfully for nontuberculous mycobacterial (NTM) lung diseases caused by different NTM species, we suggest that rifampicin should be avoided in this situation
CPA following NTM lung disease is an emerging infectious pulmonary disease that is associated with a higher mortality rate
Summary
Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary infection that is caused by Aspergillus species, and which results in destruction of lung parenchyma [1]. Despite the fact that a number of NTMs can cause chronic pulmonary diseases that result in lung destruction [10], cases that developed CPA after NTM were traditionally only rarely reported. The diagnosis of this condition was often delayed, and management was a challenge due to drug–drug interaction, which resulted in worse prognosis. The epidemiology, pathogenesis, risk factors, clinical manifestations, management, and prognosis are discussed in detail
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