The Burden of Allergic Bronchopulmonary Aspergillosis in Post-Tuberculosis Lung Disease Patients Presenting to a Tertiary Referral Centre

<b>Background:</b> Patients with post-TB lung disease (PTLD) have a large number of complications including bronchiectasis and chronic pulmonary aspergillosis. However, the occurrence of allergic bronchopulmonary aspergillosis (ABPA) has rarely been reported in these patients <b>Aims:</b> The primary objective of this ambispective study was to estimate the prevalence of ABPA PTLD patients presenting to a tertiary referral centre. <b>Methods:</b> This cohort study evaluated the data of 1012 patients of post-tubercular lung disease patients presenting to a speciality clinic at a tertiary referral centre, over 4 years. The diagnosis of ABPA and CPA were made as per ISHAM and ESCMID/ERS criteria respectively. The presence of aspergillosis was confirmed by serological tests (IgG and IgE against <i>Aspergillus</i> by ImmunoCAP^TM and LDBiolateral^TM flow assay), <i>Aspergillus</i> PCR and fungal stains/culture. <b>Results:</b> A total of 1840 patients were screened over a period of four years. ABPA was seen in 24(2.4%) patients, while CPA was seen in 120(11.9%) patients. 6(24%) patients had both. The mean age of the population was 39±15 years and there were 526 males(52%). Cough(73%), breathlessness(72%) and hemoptysis(32%) were the most common complaints. On chest imaging, nodules(54%) and lung cavity(36%) were the most common radiological features. High attenuation mucus(HAM) was seen in 4.2% of patients with ABPA. 55% and 40% of these patients received itraconazole and steroids respectively. Relapse of ABPA was seen in 15.3% patients over 4 years. No one had TB recurrence. <b>Conclusions:</b> ABPA can occur in patients with PTLD and should be ruled out as a potential complication in these patients