Chronic Pulmonary Aspergillosis in Post Tuberculosis Patients – A prospective study

Abstract

Background:
Chronic pulmonary aspergillosis (CPA) is a progressive fungal infection that frequently develops in patients with residual lung damage following pulmonary tuberculosis (TB). The burden of CPA is increasing globally, particularly in TB-endemic regions such as Indonesia. Early diagnosis remains challenging due to overlapping clinical features with post-TB lung disease and limited access to diagnostic tools.

Methods:
This prospective study evaluated patients aged >18 years who presented with persistent respiratory symptoms after completion of TB therapy. Participants with negative GeneXpert and/or acid-fast bacilli smear results were enrolled. Patients with recent antifungal therapy or HIV infection were excluded. All participants underwent Aspergillus immunochromatographic technology (ICT) testing and fungal culture. CPA diagnosis was based on persistent respiratory symptoms, microbiological evidence of Aspergillus infection, and supportive clinical findings. Demographic, clinical, and laboratory variables were compared between CPA and non-CPA groups using appropriate statistical tests.

Results:
A total of 60 patients were included, with 30 patients in the CPA group and 30 in the non-CPA group. The majority were male (67%), with a mean age of 51 years. Cough (57% vs 27%, p = 0.018) and haemoptysis (53% vs 27%, p = 0.030) were significantly more common among CPA patients. CPA patients also had a longer duration of TB treatment (12.4 vs 8.1 months, p < 0.001) and a higher prevalence of smoking history (67% vs 33%, p = 0.008). Aspergillus culture positivity was significantly higher in CPA patients (100%) compared with non-CPA patients (30%) (p < 0.001). Aspergillus fumigatus was the most commonly isolated species, followed by Aspergillus niger and Aspergillus flavus. Mixed fungal infections, particularly Aspergillus with Candida, were more frequently observed in CPA patients.

Conclusion:
CPA is a significant complication among patients with prior tuberculosis. Persistent respiratory symptoms, prolonged TB treatment, smoking history, and positive Aspergillus cultures were strongly associated with CPA in this study population. Early screening for CPA in patients with persistent symptoms after TB treatment may improve diagnosis and clinical management, particularly in TB-endemic settings.