P254 Chronic pulmonary aspergillosis in patients with non-tuberculous mycobacterial disease

<h3>Introduction</h3> Chronic pulmonary aspergillosis (CPA) can be a complication of non-tuberculous mycobacteria pulmonary disease (NTM-PD). In this context, CPA is often difficult to diagnose as both CPA and NTM-PD present with similar symptoms and chronic cavitatory changes on cross-sectional imaging. Identification of CPA is however crucial given high rates of morbidity and mortality with concurrent infection. <h3>Methods</h3> We conducted a retrospective study of consecutive NTM-PD patients identified at our trust between 2016 and 2024. NTM-PD was defined as per American Thoracic Society guidelines (clinical, radiological and microbiological criteria - two or more positive and consistent sputum isolates, a bronchoalveolar lavage sample or biopsy). Clinical information including aspergillus serology and microbiological data was extracted from patient electronic health records. <h3>Results</h3> Eighty-four patients with NTM-PD were identified. Of these, 43 (51%) were female. The median age was 66 years (IQR 23). Thirty-six (43%) patients had a background of bronchiectasis, 27 (32%) patients had COPD, seven (8%) patients had both COPD and bronchiectasis, and 14 (17%) patients had no underlying lung disease. Fourty-eight (57%) patients had <i>Mycobacterium avium</i> complex (MAC), 13 <i>Mycobacterium abscessus</i>(15%) 13 <i>Mycobacterium kansasii</i> (15%). Ten (12%) patients isolated other mycobacterial species including <i>Mycobacterium Szulgai</i> and <i>Mycobacteria Europeam</i>. Sixteen (19%) patients had an elevated aspergillus-specific IgG greater than 75mg/L. Ten were not commenced on anti-fungal treatment, one was considered for treatment but passed away prior to commencement. Of the five that were commenced on treatment all received Triazoles [Itraconazole, Voriconazole, Posaconazole] and two received Amphotericin B. Nine (11%) patients had direct evidence of aspergillus infection on sputum, bronchoalveolar lavage culture or on biopsy. <h3>Conclusion</h3> CPA should be considered when NTM-PD patients present with progression of symptoms and/or radiological changes despite appropriate treatment for their NTM-PD. Serial aspergillus serology and fungal cultures aids diagnosis.