Chronic Pulmonary Aspergillosis in Post Tuberculosis Patients in Indonesia and the Role of LDBio Aspergillus ICT as Part of the Diagnosis Scheme.

Robiatul Adawiyah,Harmi Rosianawati,Heidy Agustin,Jamal Zaini,Mulyati Tugiran,Findra Setianingrum,Chris Kosmidis,Diah Handayani,Erlina Burhan,Ridhawati Syam,Anna Rozaliyani,Retno Wahyuningsih

doi:10.3390/jof6040318

Abstract

Chronic pulmonary aspergillosis (CPA) is a common sequela of pulmonary tuberculosis (TB). The diagnosis of CPA is difficult and often misdiagnosed as smear-negative TB in endemic settings. Aspergillus IgG detection is the cornerstone of CPA diagnosis. There are a lack of studies on the prevalence of CPA in GeneXpert/smear-negative TB patients in Indonesia, despite a high number of TB cases. This study aims to determine the CPA rate in HIV-negative, GeneXpert-negative patients presenting with symptoms following completion of TB therapy and to evaluate the performance of LDBio Aspergillus immunochromatographic technology (ICT) lateral flow assay in the diagnosis of CPA. CPA was diagnosed on the basis of symptoms for ≥3 months, characteristic chest imaging and positive Aspergillus culture. Twenty (22%) out of 90 patients met the criteria for CPA. The LDBio test was positive in 16 (80%) CPA patients and in 21 (30%) non-CPA patients (p < 0.001) with 80% sensitivity and 70% specificity. Logistic regression revealed a positive LDBio Aspergillus ICT result, smoking history and diabetes to be important predictors of CPA diagnosis. Although CPA is an unrecognised disease in Indonesia, this study suggests that more than one in five GeneXpert negative patients with persistent symptoms following completion of TB therapy may have CPA.

Highlights

Aspergillosis can present as a chronic and progressive disease of the lung, called chronic pulmonary aspergillosis (CPA)
TB therapy were recruited from Persahabatan National Respiratory Referral Hospital (Jakarta) and
We show that more than one in five HIV-negative patients who present ongoing symptoms and a negative GeneXpert test following completion of TB therapy may have CPA

Summary

Introduction

Aspergillosis can present as a chronic and progressive disease of the lung, called chronic pulmonary aspergillosis (CPA). This emerging disease affects more than 3 million people around the world, mainly survivors of pulmonary tuberculosis (TB) with estimates suggesting that more than 100,000 people develop CPA yearly as a consequence of TB [1,2]. The survival rate of CPA can be as low as 47% at. J. Fungi 2020, 6, 318; doi:10.3390/jof6040318 www.mdpi.com/journal/jof. The rate of CPA at the end of TB therapy in smear-negative, HIV-negative patients was 14.5% in a prior study in Nigeria [4]

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