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 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 Performance of LDBio Aspergillus WB and ICT Antibody Detection in Chronic Pulmonary Aspergillosis

2021 ◽  
Vol 7 (4) ◽  
pp. 311
Author(s):  
Anna Rozaliyani ◽  
Findra Setianingrum ◽  
Sresta Azahra ◽  
Asriyani Abdullah ◽  
Ayu Eka Fatril ◽  
...  
Keyword(s):  
Receiver Operating Curve ◽  
Antibody Detection ◽  
Pulmonary Aspergillosis ◽  
Comparative Performance ◽  
Tuberculosis Patients ◽  
Chronic Pulmonary Aspergillosis ◽  
Screening Assays ◽  
Roc Area ◽  
Flow Detection ◽  
Sensitivity Specificity

The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.

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 Role of fiberoptic bronchoscopy in sputum smear negative suspected cases of pulmonary tuberculosis: a study conducted in Southern part of Rajasthan

2020 ◽  
Vol 8 (12) ◽  
pp. 4302
Author(s):  
Atul Luhadia ◽  
Shanti K. Luhadia ◽  
Shubham Jain ◽  
Mohammad Hamza Hanfe ◽  
Divax Oza ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Diagnostic Yield ◽  
Radiological Finding ◽  
Fiberoptic Bronchoscopy ◽  
Sputum Smear ◽  
Tuberculosis Patients ◽  
Acid Fast Bacilli ◽  
Predominant Symptom ◽  
Smear Negative

Background: Sputum smear negative pulmonary tuberculosis is a common problem faced by clinicians. Fiberoptic bronchoscopy may be very useful in diagnosing these cases which have no sputum or whose sputum smear is negative for acid fast bacilli. Objective of the current study was to assess the role of fiberoptic bronchoscopy in sputum smear negative under NTEP and radiologically suspected cases of pulmonary tuberculosis.Methods: Clinico-radiological suspected cases of pulmonary tuberculosis patients in whom two sputum smear for acid fast bacilli by Ziehl Neelsen stain under NTEP was negative were included in the study. Fiberoptic bronchoscopy was performed in all these patients and samples taken were sent for investigations.Results: Fiberoptic bronchoscopy was performed in 250 patients of suspected pulmonary tuberculosis whose sputum for AFB smear was negative. Cough was the most predominant symptom. Radiologically, right side disease was more common and upper zone was most commonly involved and infiltrates were common radiological finding. During bronchoscopy, congestion and hyperaemia (36%) and mucopurulent/mucoid secretions (32%) was seen in maximum number of cases. BAL was positive in 200 patients (80%), post bronchoscopy sputum was positive in 70 cases (28%) and biopsy was positive in 12 patients out of 16 performed biopsies (75%). The total TB positive cases after combining all the methods were 215 making the overall diagnostic yield of 86%.Conclusions: Fiberoptic bronchoscopy and post bronchoscopy sputum can be very useful for diagnosing sputum for AFB smear negative but clinico-radiological suspected cases of pulmonary tuberculosis patients.

scholarly journals Long-term follow-up: tuberculosis, bronchiectasis and chronic pulmonary aspergillosis

Pneumologia ◽  
2019 ◽  
Vol 68 (3) ◽  
pp. 138-143
Author(s):  
Oxana Munteanu ◽  
Dumitru Chesov ◽  
Doina Rusu ◽  
Irina Volosciuc ◽  
Victor Botnaru
Keyword(s):  
Past History ◽  
Natural Evolution ◽  
Pulmonary Aspergillosis ◽  
Long Term Follow Up ◽  
History Of ◽  
Chronic Pulmonary Aspergillosis ◽  
The Impact

Abstract Pulmonary sequelae related to tuberculosis (TB) are among the major causes of bronchiectasis in Eastern Europe. The role of bacterial colonisation in the pathogenesis of bronchiectasis has been continuously studied over the last decades, less understood remains the impact of fungal infection, alone or in association with bacterial. Although the data on the development of chronic pulmonary aspergillosis (CPA) secondary to TB are scarce, recent evidence suggests a higher prevalence of CPA in patients with a past history of pulmonary TB than it was previously estimated. We present a case of natural evolution of CPA, with a radiological follow-up, in a patient with post-tuberculous bronchiectasis.

scholarly journals Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians

2017 ◽  
Vol 21 (9) ◽  
pp. 1056-1061 ◽  
Author(s):  
R. O. Oladele ◽  
N. K. Irurhe ◽  
P. Foden ◽  
A. S. Akanmu ◽  
T. Gbaja-Biamila ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Pulmonary Aspergillosis ◽  
Tb Treatment ◽  
Chronic Pulmonary Aspergillosis ◽  
Smear Negative

scholarly journals Comparative Evaluation of Profiles of Antibodies to Mycobacterial Capsular Polysaccharides in Tuberculosis Patients and Controls Stratified by HIV Status

2011 ◽  
Vol 19 (2) ◽  
pp. 198-208 ◽  
Author(s):  
Xian Yu ◽  
Rafael Prados-Rosales ◽  
Elisabeth R. Jenny-Avital ◽  
Katherine Sosa ◽  
Arturo Casadevall ◽  
...  
Keyword(s):  
Malate Synthase ◽  
Hiv Positive ◽  
Sputum Smear ◽  
Capsular Polysaccharides ◽  
Hiv Status ◽  
Tuberculosis Patients ◽  
Smear Negative ◽  
Mycobacterial Antigens ◽  
Hiv Negative ◽  
Asymptomatic Hiv

ABSTRACTDespite the complexity of tuberculosis (TB) serology, antibodies (Abs) remain attractive biomarkers for TB. Recent evidence of a mycobacterial capsule that consists mainly of the polysaccharides arabinomannan (AM) and glucan provides new options for serologic targets. For this study, Ab responses to AM and glucan for 47 U.S. TB patients (33 HIV negative [HIV−], 14 HIV positive [HIV+]), 42 healthy controls, and 38 asymptomatic HIV+controls were evaluated by enzyme-linked immunosorbent assays (ELISAs). The results were compared with Ab responses to the mycobacterial glycolipid cell wall antigen lipoarabinomannan (LAM) and to the proteins malate synthase (MS) and MPT51. We found that the main immunoglobulin (Ig) isotype response to polysaccharides was IgG, predominantly of subclass IgG2. IgG responses to AM were significantly higher for HIV−and HIV+TB cases than for controls (P, <0.0001 and <0.01, respectively); significantly higher for HIV−than for HIV+TB cases (P, <0.01); and significantly higher in sputum smear-positive than smear-negative patients in both HIV−and HIV+cases (P, 0.01 and 0.02, respectively). In both TB groups, titers of Ab to glucan were significantly lower than titers of Ab to AM (P, <0.0001). IgG responses to AM and MS or to AM and MPT51 did not correlate with each other in HIV−TB patients, while they correlated significantly in HIV+TB patients (P, 0.01 and 0.05, respectively). We conclude that Ab responses to AM could contribute to the serodiagnosis of TB, especially for HIV−TB patients. This study also provides new and important insights into the differences in the profiles of Abs to mycobacterial antigens between HIV−and HIV+TB patients.

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