Aspergillosis and Post-Tuberculosis Lung Disease: A Relevant and Neglected Association

Chronic cavitary pulmonary aspergillosis (CCPA) is a disease that is difficult to diagnose and associated with high mortality. Sequelae of previous respiratory disease, such as tuberculosis, are risk factors for the development of CCPA. This study aimed to describe CCPA cases identified in a hospital in northeastern Brazil. Cross-sectional study based on medical record review of patients diagnosed with CCPA between January 2020 and August 2024, followed at a specialized medical mycology outpatient clinic in a hospital in northeastern Brazil. Adults aged ≥18 years with a clinical and radiological diagnosis of CCPA were included. Descriptive analysis was performed using STATA 18.0 software. We included 21 patients with CCPA. Most were female (52.4%), with a median age of 50 36–67 years. In addition, 85.7% lived in urban areas and 90.5% had low educational level. Post-tuberculosis lung disease (PTLD) was present in 71.4% of patients with CCPA. The main symptoms were cough (71.4%) and hemoptysis (61.9%). Radiologically, cavitations (76.2%) and bronchiectasis (33.3%) were the most frequent findings. Aspergillus spp. isolation in culture of respiratory samples was observed in six patients: four from bronchoalveolar lavage (BAL) and two from sputum. In two patients, fungal infection was identified by histopathologic analysis of lung tissue. Two patients had positive galactomannan in BAL. Eight patients underwent serology for aspergillosis, which was reactive in 50% of cases. Five fungal isolates were identified only at the genus level, and one isolate was identified as A. fumigatus. Nine patients (42.8%) had a purely clinical-radiological diagnosis. Regarding treatment, 18 patients received antifungals: 50% itraconazole, 38.8% itraconazole plus voriconazole, 5.6% voriconazole alone, and 5.6% amphotericin B plus azole antifungals. During follow-up, 42.8% of patients were lost to follow-up. CCPA is a poorly recognized and neglected disease, despite the high prevalence of tuberculosis in our region. Therefore, in patients with chronic respiratory symptoms and radiological changes such as cavitation and a history of tuberculosis, CCPA associated with PTLD should always be considered.