Abstract
Chronic pulmonary aspergillosis (CPA) has a wide spectrum of illnesses depending on the progression of the disease and comorbid conditions. However, there is an inadequacy of investigations regarding clinical, laboratory, risk factor and prognostic data on CPA. The current study is aimed to consider the clinical manifestations, risk factors and outcomes of CPA. Retrospective records of all patients with a confirmed diagnosis of CPA who sought treatment at Gulab Devi Chest Hospital Lahore, Pakistan from January 2017 to December 2019 were evaluated. Data regarding demographics, clinical manifestations, comorbidities, radiographic and microbiological findings, length of hospital stay (LOS) and intensive care unit (ICU) admission was collected and analyzed to identify the factors associated with mortality. The independent factors associated with mortality were also identified by appropriate analyses. A total of 218 CPA patients were included in this study. The mean age was 45.75 ± 6.26 years. Of these, 160 (73.4%) were male, and 65 (29.8%) had diabetes. The mean LOS was 18.5 ± 10.9 days. The most common type of CPA was simple aspergilloma (56%) followed by chronic cavitary pulmonary aspergillosis (CCPA) (31.2%). About one half of the patients had a history of pulmonary tuberculosis (TB) and treatment response rates were low in patients with active TB. The overall mortality rate was 27.1%. ICU admission was required for 78 (35.8%) patients. Diabetes mellitus (DM), hematological malignancies and chronic kidney disease (CKD) were the common underlying conditions predicting a poor outcome. Mean LOS, hematological malignancies, consolidation and ICU admission were identified as the independent factors leading to mortality. CPA had a significant association with TB in the majority of cases. Treatment response rates in cases with active TB were comparatively low. Cases with high mean LOS, hematological malignancies, consolidation, ICU admission, CKD and DM experienced poor outcomes. High mean LOS, hematological malignancies, consolidation and ICU stay were identified as independent risk factors for mortality. Future large prospective studies, involving aspergillus specific immunoglobulin G (IgG) antibody testing, are required for a better understanding of CPA in Pakistan.
Highlights
Aspergillus species are ubiquitous in the environment and exposure to the conidia is common
About one half of the patients had a history of pulmonary tuberculosis (TB) and treatment response rates were low in patients with active TB
High mean length of hospital stay (LOS), hematological malignancies, consolidation and intensive care unit (ICU) stay were identified as independent risk factors for mortality
Summary
Aspergillus species are ubiquitous in the environment and exposure to the conidia is common. Chronic pulmonary aspergillosis (CPA) in immunocompetent patients presents as a saprophytic infection in a pre-existing cavity, often following an infection such as TB or prior lung surgery [2]. The key features of CPA include steady destruction of lung tissue showing progressive cavity formation, fibrosis, and pleural thickening. SAIA occurs in the cases with some degree of immune compromise, and may present with nodules, consolidation or cavitation upon chest imaging, and a more rapidly progressing clinical course. CCPA presents with single or multiple cavities, with or without aspergilloma(s), and CFPA has the same appearance with the added features of pulmonary fibrosis, which may be progressive and destructive [2]. The current study is aimed to consider the clinical manifestations, risk factors and outcomes of CPA
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