Clinical and laboratory profile of chronic pulmonary aspergillosis: a retrospective study

Abstract

IntroductionChronic pulmonary aspergillosis (CPA) is a type of semi-invasive aspergillosis seen mainly in immunocompetent individuals. These are slow, progressive, and not involved in angio-invasion compared with invasive pulmonary aspergillosis. The predisposing factors being compromised lung parenchyma owing to chronic obstructive pulmonary disease and previous pulmonary tuberculosis. As not many studies have been conducted in CPA with respect to clinical and laboratory profile, the study was undertaken to examine the profile in our population.Patients and methodsThis was a retrospective study. All patients older than 18 years, who had evidence of pulmonary fungal infection on chest radiography or computed tomographic scan, from whom the Aspergillus sp. was isolated from respiratory sample (broncho-alveolar wash, bronchoscopic sample, etc.) and diagnosed with CPA from 2008 to 2016, were included in the study.ResultsA total of 30 patients were included in the study. Most patients presented with pulmonary symptoms like cough with expectoration, hemoptysis, fever, breathlessness, and chest pain. Among the systemic comorbid conditions, diabetes mellitus was the most common (7/30), and nearly 50% (14/30) of the patients had a history of pulmonary tuberculosis. Among the hematological parameters, a significant difference was observed in hemoglobin, total leukocyte count, differential leukocyte count, and erythrocyte sedimentation rate. In all the four dead patients, the cause of death was respiratory failure and all patients were previously treated for pulmonary tuberculosis.ConclusionWhen a patient with pre-existing lung disease like chronic obstructive pulmonary disease or old tuberculosis cavity presents with cough with expectoration, breathlessness, and hemoptysis, CPA should be considered as the first differential diagnosis.