ASPERGILOSE PULMONAR CRÔNICA EM UMA COORTE DE PACIENTES COM TUBERCULOSE PULMONAR ATIVA EM MATO GROSSO DO SUL, BRASIL.

Abstract

Introduction: Chronic pulmonary aspergillosis (CPA) classically affects individuals with a history of treated pulmonary tuberculosis (PTB); however, the concomitant occurrence of both diseases tends to be underestimated, considering the difficulties in diagnosing CPA, the overlap of symptoms, and the lack of clinical suspicion. Furthermore, older guidelines recommended ruling out active PTB before diagnosing CPA. Therefore, the prevalence of CPA during active TB has been poorly studied and deserves careful investigation. Objective: To investigate the frequency and associated factors of CPA in a prospective cohort of patients with active PTB. Methods: This was an epidemiological, observational study involving a cohort of patients with active PTB treated between January 2022 and December 2023 at three hospitals in Mato Grosso do Sul, Brazil. Patients underwent clinical evaluations, laboratory tests, and chest computed tomography (CT) scans for CPA investigation. Associations between groups (with and without CPA) were analyzed using the chi-square test or Fisher’s exact test for categorical variables and Student's t-test or Mann-Whitney test for numerical variables. A p-value < 0.05 was considered statistically significant. Study participants were followed after the PTB diagnosis to assess survival outcomes. Results: A total of 147 patients with active PTB were included. The prevalence of CPA was 6.8% [95% CI: 3.3% - 12.5%] among all participants; 5.3% [95% CI: 2.3% – 11.9%] among those experiencing their first episode of PTB; and 3.1% [95% CI: 0.5% - 15.7%] among those with laboratory-confirmed PTB. Of the 10 patients diagnosed with CPA, most were classified as having chronic cavitary pulmonary aspergillosis (n=9), and eight were categorized as confirmed CPA, with four diagnosed through mycological examination and five through serology. CT scans revealed changes suggestive of CPA in 90% of these patients. The main findings included cavities (90.0%), pulmonary infiltrates (80.0%), and pleural thickening (60.0%). Finally, the case fatality rate for PTB was 15.3%, with no significant difference in the frequency or time to death during the study period between patients with and without CPA. Three CPA patients were living with HIV/AIDS. Conclusion: The observed 6.8% prevalence of CPA among patients with active PTB in this study justifies investigating this neglected fungal infection in patients with active tuberculosis. In addition to clinical evaluation, CT scans and serological tests are important tools for CPA investigation, given that no clinical differences were observed between patients with PTB alone and those with both PTB and CPA.