Importance of Aspergillus-Specific Antibody Screening for Diagnosis of Chronic Pulmonary Aspergillosis after Tuberculosis Treatment: A Prospective Follow-Up Study in Ghana

Chronic pulmonary aspergillosis (CPA) often occurs in patients that have been previously treated for pulmonary tuberculosis (PTB). A limited number of studies have looked at the development of CPA at different times following the completion of a PTB treatment course. This prospective longitudinal study aimed to determine the incidence of CPA at two timepoints, at the end of the PTB treatment (T(1)) and six months post-treatment (T(2)). Patients with confirmed PTB from a previous study who were placed on anti-TB medication were followed up and screened for CPA at T(1) and T(2) by assessing their symptoms, evaluating their quality of life, and screening them for Aspergillus infection by performing antibody testing and cultures. CPA was defined by the Global Action for Fungal Infections (GAFFI) diagnostic algorithm. Forty-one patients were enrolled, of whom thirty-three patients (80%) and twenty-eight patients (68%) were resurveyed at T(1) and T(2,) respectively. The rate of new CPA was 3.3% (1/33) and 7.4% (2/27) at T(1) and T(2), respectively, with an overall incidence of 10.7% (3/28) among the patients at both T(1) and T(2). A positive Aspergillus-specific antibody test was an indicator for CPA in all three patients. Aspergillus-specific antibody screening during and after the end of an anti-TB treatment regimen may be important for early detection of CPA in high-PTB-burden settings.