P388 High rate of chronic pulmonary aspergillosis in active TB patients in Indonesia with GeneXpert positive

POSTER SESSION 3, SEPTEMBER 23, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: Chronic pulmonary aspergillosis (CPA) commonly affects post-tuberculosis (TB) patients. However, the existence of this slowly destructive disease is also increasingly being reported in patients with active TB. The study aimed to identify the clinical, radiological, and serological characteristics of probable CPA patients between proven TB with GeneXpert positive and clinically diagnosed TB (GeneXpert negative) in early TB therapy. METHODS: All patients were on anti-tuberculous therapy in the early phase (0–2 months). Clinical profiles and radiology findings were collected from hospitals in Jakarta and Depok, Indonesia. Aspergillus antibodies were measured using Immulite automated ELISA. Sputum was tested for TB with GeneXpert MTB/RIF assay. RESULT: A total of 70 patients with a median age of 37 years were studied. Overall, 29% (n = 20) met the criteria for proven or probable CPA. The rate of CPA in GeneXpert positive was 50%, whereas it was only 14% in GeneXpert negative patients (P = .001). Most of CPA patients had GeneXpert result intermediate (n = 7, 35%), 4 of them (6%) had a high load of TB proven by GeneXpert. Cough was the most common symptom in GeneXpert positive groups (n = 11, 39%). Fatigue was frequently founded in GeneXpert negative groups (n = 8, 19%). The proportion of cavities (90% vs 44%), paracavitary fibrosis (70% vs 26%), and pleural thickening (60% vs 24%) were significantly higher in CPA patients. The median score of Aspergillus antibody in non-CPA patients was lower (7.7, range 3.1-15.2 mg/L) compare with CPA patients (11.9, range 4.3-344 mg/L) (P = .024). CONCLUSION: Aspergillus spp is a fatal fungal pathogen that might cause co-infection in active TB patients. The measurement of Aspergillus antibodies is a hallmark for the diagnosis of CPA. The coexistence of CPA in active TB patients is underdiagnosed.