Abstract / Summary
Abstract Background: Chronic pulmonary aspergillosis (CPA) is a possible diagnosis in patients evaluated for pulmonary tuberculosis (PTB), especially in resource limited settings with high TB burden. Its clinical presentation closely mimics PTB, often resulting in missed diagnosis and delayed initiation of treatment. This study aimed to describe the prevalence, clinical presentation, antifungal susceptibility profiles and factors associated with CPA among PTB suspects in Mulago National Referral Hospital.
Methods: This was a cross-sectional study conducted between February and May 2025 at Mulago National Referral Hospital, Kampala, Uganda. We consecutively enrolled adult patients with persistent respiratory symptoms, suspected to have PTB. All participants underwent Gene Xpert MTB/RIF testing of sputum and fungal culture using Sabouraud dextrose agar. CPA was diagnosed based on the presence of compatible symptoms lasting two weeks or more, positive Aspergillus culture, and radiological findings. Antifungal susceptibility testing was done using gradient strips to determine minimum inhibitory concentrations. Multivariable logistic regression was used to identify predictors of CPA.
Results: Of the 135 participants (median age 35 years, IQR: 28-49; 62.2% male), CPA was diagnosed in 13.3% (18/135), with 5.9% (8/135) having CPA with active PTB and 7.4% (10/135) having CPA without PTB. Additionally, 31.9% (43/135) had PTB without CPA, and 54.8% (74/135) had neither PTB nor CPA. The most common Aspergillus species isolated were A. fumigatus (38.1%), A. niger (38.1%), and A. flavus (28.6%). Common clinical presentations included productive cough, fever, hemoptysis, and chest pain in CPA cases. Pulmonary fibrosis (66%) was the most common radiological finding among CPA patients. Antifungal susceptibility testing revealed complete sensitivity to voriconazole while resistance to amphotericin B was observed in 31% of the isolates. Longer duration of symptoms (adjusted odds ratio [aOR]: 1.22 per week; 95% CI: 1.06-1.41; p=0.006), chest pain (aOR: 3.05; 95% CI: 1.02-9.96; p=0.052), and TB exposure (aOR: 3.57; 95% CI: 1.11-12.08; p=0.034) were independently associated with CPA, Conclusions: About 13.3% patients suspected to have PTB in Uganda have CPA with clinical presentation similar to PTB, mostly caused by A. fumigatus and A. niger. CPA should be screened among PTB suspects to improve early case detection and patient outcomes.