scholarly journals Misdiagnosis of chronic pulmonary aspergillosis as pulmonary tuberculosis at a tertiary care center in Uganda: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Richard Kwizera ◽  
Andrew Katende ◽  
Felix Bongomin ◽  
Lydia Nakiyingi ◽  
Bruce J. Kirenga
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Diagnostic Criteria ◽  
Tertiary Care ◽  
Chest Imaging ◽  
Resource Limited Settings ◽  
Pulmonary Aspergillosis ◽  
Resource Limited ◽  
Chronic Pulmonary Aspergillosis ◽  
Hiv Negative

Abstract Background Diagnosis of chronic pulmonary aspergillosis (CPA) is based on a combination of clinical symptomatology, compatible chest imaging findings, evidence of Aspergillus infection and exclusion of alternative diagnosis, all occurring for more than 3 months. Recently, a rapid, highly sensitive and specific point-of-care lateral flow device (LFD) has been introduced for the detection of Aspergillus-specific immunoglobulin (Ig)G, especially in resource-limited settings where CPA is underdiagnosed and often misdiagnosed as smear-negative pulmonary tuberculosis (PTB). Therefore, in our setting, where tuberculosis (TB) is endemic, exclusion of PTB is an important first step to the diagnosis of CPA. We used the recently published CPA diagnostic criteria for resource-limited settings to identify patients with CPA in our center. Case presentation Three Ugandan women (45/human immunodeficiency virus (HIV) negative, 53/HIV infected and 18/HIV negative), with a longstanding history of cough, chest pain, weight loss and constitutional symptoms, were clinically and radiologically diagnosed with PTB and empirically treated with an anti-tuberculous regimen despite negative microbiological tests. Repeat sputum Mycobacteria GeneXpert assays were negative for all three patients. On further evaluation, all three patients met the CPA diagnostic criteria with demonstrable thick-walled cavities and fungal balls (aspergilomas) on chest imaging and positive Aspergillus-specific IgG/IgM antibody tests. After CPA diagnosis, anti-TB drugs were safely discontinued for all patients, and they were initiated on capsules of itraconazole 200 mg twice daily with good treatment outcomes. Conclusions The availability of simple clinical diagnostic criteria for CPA and a LFD have the potential to reduce misdiagnosis of CPA and in turn improve treatment outcomes in resource-limited settings.

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

2020 ◽  
Vol 6 (4) ◽  
pp. 318
Author(s):  
Anna Rozaliyani ◽  
Harmi Rosianawati ◽  
Diah Handayani ◽  
Heidy Agustin ◽  
Jamal Zaini ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Smoking History ◽  
Chest Imaging ◽  
Pulmonary Aspergillosis ◽  
Tuberculosis Patients ◽  
Persistent Symptoms ◽  
Chronic Pulmonary Aspergillosis ◽  
Smear Negative ◽  
Hiv Negative

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.

scholarly journals Correlates of Treatment Outcomes and Drug Resistance among Pulmonary Tuberculosis Patients Attending Tertiary Care Hospitals of Kolkata, India

PLoS ONE ◽  
2014 ◽  
Vol 9 (10) ◽  
pp. e109563 ◽  
Author(s):  
Avranil Goswami ◽  
Urmita Chakraborty ◽  
Tanmay Mahapatra ◽  
Sanchita Mahapatra ◽  
Tapajyoti Mukherjee ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Tertiary Care ◽  
Tuberculosis Patients ◽  
Tertiary Care Hospitals

scholarly journals Chronic Pulmonary Aspergillosis Misdiagnosed as Smear-Negative Pulmonary Tuberculosis in a TB Clinic in Nigeria

2018 ◽  
Vol 26 (10) ◽  
pp. 1-5 ◽  
Author(s):  
Titilola Gbaja-Biamila ◽  
Felix Bongomin ◽  
Nicholas Irurhe ◽  
Augustina Nwosu ◽  
Rita Oladele
Keyword(s):  
Pulmonary Tuberculosis ◽  
Pulmonary Aspergillosis ◽  
Chronic Pulmonary Aspergillosis ◽  
Smear Negative

scholarly journals Haemoptysis in a female with diabetes mellitus: a unique presentation of chronic pulmonary aspergillosis, pulmonary tuberculosis, and Klebsiella peumoniae co‐infection

2016 ◽  
Vol 4 (4) ◽  
pp. 432-436 ◽  
Author(s):  
Chinonso Ekwueme ◽  
Akaninyene Asuquo Otu ◽  
Sunny Chinenye ◽  
Chioma Unachukwu ◽  
Reginald N. Oputa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Pulmonary Tuberculosis ◽  
Pulmonary Aspergillosis ◽  
Chronic Pulmonary Aspergillosis

scholarly journals Mapping of Chronic Pulmonary Aspergillosis in Africa

2021 ◽  
Vol 7 (10) ◽  
pp. 790
Author(s):  
Ronald Olum ◽  
Iriagbonse Iyabo Osaigbovo ◽  
Joseph Baruch Baluku ◽  
Jannik Stemler ◽  
Richard Kwizera ◽  
...  
Keyword(s):  
Risk Factor ◽  
Pulmonary Tuberculosis ◽  
Case Reports ◽  
Case Series ◽  
Important Risk Factor ◽  
Chronic Obstructive ◽  
Extensive Literature ◽  
African Countries ◽  
Pulmonary Aspergillosis ◽  
Chronic Pulmonary Aspergillosis

Africa has a high burden of tuberculosis, which is the most important risk factor for chronic pulmonary aspergillosis (CPA). Our goal was to systematically evaluate the burden of CPA in Africa and map it by country. We conducted an extensive literature search for publications on CPA in Africa using the online databases. We reviewed a total of 41 studies published between 1976 and 2021, including a total of 1247 CPA cases from 14 African countries. Most of the cases came from Morocco (n = 764, 62.3%), followed by South Africa (n = 122, 9.9%) and Senegal (n = 99, 8.1%). Seventeen (41.5%) studies were retrospective, 12 (29.3%) were case reports, 5 case series (12.2%), 5 prospective cohorts, and 2 cross-sectional studies. The majority of the cases (67.1%, n = 645) were diagnosed in men, with a median age of 41 years (interquartile range: 36–45). Active/previously treated pulmonary tuberculosis (n = 764, 61.3%), human immunodeficiency virus infection (n = 29, 2.3%), diabetes mellitus (n = 19, 1.5%), and chronic obstructive pulmonary disease (n = 10, 0.8%) were the common co-morbidities. Haemoptysis was the most frequent presenting symptom, reported in up to 717 (57%) cases. Smoking (n = 69, 5.5%), recurrent lung infections (n = 41, 3%) and bronchorrhea (n = 33, 3%) were noted. This study confirms that CPA is common in Africa, with pulmonary tuberculosis being the most important risk factor.

scholarly journals Feasibility of the home isolation programme for adults and children with COVID-19

2020 ◽  
Vol 7 (11) ◽  
pp. 1647
Author(s):  
Purwa Doke ◽  
Jitendra S. Oswal ◽  
Disha A. Padalkar ◽  
Mohit P. Jain
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Morbid Condition ◽  
Resource Limited Settings ◽  
Once Daily ◽  
Use Of Resources ◽  
Resource Limited ◽  
Hospital Beds ◽  
Adults And Children

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused an upsurge of cases in many countries leading to inadequate quarantine facilities and hospital beds. Studies on the feasibility of home isolation for COVID-19 patients are the need of the hour. This is the first study from India on the feasibility of home isolation to the best of the author's knowledge.Methods: This methodical study was conducted at a designated COVID-19 tertiary care hospital in India, which included all patients enrolled for the home isolation programme from the 4 July to 3 August 2020. Laboratory confirmed COVID-19 patients were assessed during the enrolment for their eligibility for home isolation. The enrolled patients were followed up once daily over a telephonic call with objective parameters like temperature, pulse and oxygen saturation.Results: There were a total of 447 adults and 67 children. Amongst adults, hypertension was the most common co-morbid condition seen in 23 (5.15%) followed by diabetes in 18 (4.03%) patients. Only 24 (5.37%) patients were hospitalised during the duration of home isolation due to reasons like persistent fever, decreased SpO2, and non-medical ones like anxiety regarding the disease. Age and the presence of co-morbidities were directly related to the requirement of hospitalisation. No children required hospitalisation. There were no deaths.Conclusions: Home isolation is effective for COVID-19 patients in resource limited settings. We provide strong evidence for adapting it for asymptomatic and mild symptomatic cases with judicious use of resources and without compromising the risk to patients.

scholarly journals Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation

2019 ◽  
Vol 53 (3) ◽  
pp. 1801184 ◽  
Author(s):  
Iain D. Page ◽  
Rosemary Byanyima ◽  
Sharath Hosmane ◽  
Nathan Onyachi ◽  
Cyprian Opira ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Chest Radiography ◽  
Chronic Cough ◽  
Reasonable Accuracy ◽  
Pulmonary Aspergillosis ◽  
Pulmonary Tb ◽  
Pleural Thickening ◽  
Radiological Features ◽  
Chronic Pulmonary Aspergillosis ◽  
Specific Igg

Chronic pulmonary aspergillosis (CPA) complicates treated pulmonary tuberculosis (TB), with high 5-year mortality. We measured CPA prevalence in this group.398 Ugandans with treated pulmonary TB underwent clinical assessment, chest radiography and Aspergillus-specific IgG measurement. 285 were resurveyed 2 years later, including computed tomography of the thorax in 73 with suspected CPA. CPA was diagnosed in patients without active TB who had raised Aspergillus-specific IgG, radiological features of CPA and chronic cough or haemoptysis.Author-defined CPA was present in 14 (4.9%, 95% CI 2.8–7.9%) resurvey patients. CPA was significantly more common in those with chest radiography cavitation (26% versus 0.8%; p<0.001), but possibly less frequent in HIV co-infected patients (3% versus 6.7%; p=0.177). The annual rate of new CPA development between surveys was 6.5% in those with chest radiography cavitation and 0.2% in those without (p<0.001). Absence of cavitation and pleural thickening on chest radiography had 100% negative predictive value for CPA. The combination of raised Aspergillus-specific IgG, chronic cough or haemoptysis and chest radiography cavitation had 85.7% sensitivity and 99.6% specificity for CPA diagnosis.CPA commonly complicates treated pulmonary TB with residual chest radiography cavitation. Chest radiography alone can exclude CPA. Addition of serology can diagnose CPA with reasonable accuracy.

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