P128 Chronic pulmonary aspergillosis in a Tuberculosis c enter of Assam—a 2-year study

Abstract

Objectives: Chronic pulmonary aspergillosis is a slow and progressive lung disease that occurs in apparently immune-competent patients. Pulmonary tuberculosis is considered to be a major predisposing factor. Early diagnosis of the condition can improvemorbidity andmortality.Asthe number ofstudies todetect thisdisease in Indiais sparse, this studywas undertaken in DistrictTuberculosis centerattached toAssam MedicalCollege and Hospital, Dibrugarh t ofind outthe occurrence of chronic pulmonary aspergillosis in treated pulmonary TB patients. Method(s): This prospective hospital-based cross-sectional study was done in Assam Medical College and Hospital, Di-brugarh from December 2015-November 2017. Every consecutive pulmonary TB case after completion of intensive therapy attending the outpatient department with respiratory symptoms was included in the study. Cases were identified with clinical, serological/mycological, and radiological criteria. Result(s): A total of 26 cases of CPA were confirmed out of 211 enrolled cases.Positivity rate of CPA in the enrolled patients was 12.3% (95% CI8.19-17.51%).The hospital-based occurrence rate wasfound to be 6/1000 (95% CI3.8-8.5) in the outdoor attendants in DTC, Dibrugarh.Most of the cases (88.46%) were late cases presenting with aspergilloma.Majority (51.72%) of the aspergilloma cases were detected within 5 years of diagnosis of PTB. Very few (15.38%, n = 4) early cases were detected. The sensitivity of the ELISA test (DRG, Germany) was found to be 72.72% as compared with reference Immunocap method used in this study. A section (37.90%) of the patients with fungal ball was seronegative by Aspergillus fumigatus serological test. Two of them were positive for Aspergillus flavus in sputum culture. Conclusion(s): A serological test to detect Aspergillus flavus IgG may complement the Aspergillus fumigatus IgG test in detecting CPA. CPA is a neglected disease with a high morbidity and mortality. Routine follow-up protocol for the cavitary patients in tuberculosis center by a sensitive serological test for a minimum period of 5 years may be necessary for early detection of cases in PTB high prevalence countries.