EVOLUÇÃO CLÍNICA E ANÁLISE DO TRANSCRIPTOMA DE MONÓCITOS NA ASPERGILOSE PULMONAR CRÔNICA

Abstract

Chronic pulmonary aspergillosis (CPA) is a progressive fungal infection that affects individuals with structural lung damage, particularly following pulmonary tuberculosis (PTB). To investigate the clinical, prognostic, and immunogenomic aspects of CPA, an observational cohort study was conducted involving 30 patients treated between September 2014 and July 2024 at a university hospital in Brazil. The median age was 55.5 years; 70% were male and 70% had a history of PTB. Quality of life was assessed in 14 patients using the St. George’s Respiratory Questionnaire (SGRQ), with a median total score of 61.78 and domain scores for symptoms (53.64), activity (63.57), and impact (59.16). Clinical improvement at six and twelve months was observed in 55.6% and 47.4% of patients, respectively, while radiological improvement occurred in only 36.8%. One patient achieved cure, 10% completed treatment, 13.3% experienced recurrence or failure, and 23.3% died. In univariate analysis, deceased patients had longer delays between symptom onset and treatment initiation (p = 0.014), lower rates of positive fungal cultures (p = 0.031), and higher levels of C-reactive protein (p = 0.012), leukocytes (p = 0.007), and monocytes (p = 0.012). Hypoalbuminemia was associated with reduced survival in the Cox regression model (p = 0.0499). Transcriptomic analysis of monocytes revealed overexpression of EIF1AY and TTTY15 (genes located on the Y chromosome, detected in female samples, without biological relevance) in CPA patients, and underexpression of the JCHAIN gene in PTB-treated controls, suggesting possible impairment of mucosal adaptive immunity. These findings reinforce the dissociation between clinical improvement and radiological progression and suggest that systemic inflammation and treatment delay may serve as prognostic markers in CPA. Keywords: Aspergilloma. Pulmonary Aspergillosis. Monocytes. PBMC. Transcriptome.