Chronic Pulmonary Aspergillosis Prevalence Among Clinical Pulmonary Tuberculosis in Northern Vietnam

Abstract Rationale: Pulmonary Tuberculosis may mimic Chronic Pulmonary Aspergillosis (CPA) in clinical symptoms and abnormality in chest radiography. Therefore, mistaken diagnosis may occur in pulmonary tuberculosis patients without bacteriological confirmation, especially among those who had been previously treated for TB. Vietnam is one of the 30 high-burden countries with around 19% CPTB annually. We conducted the assessment to identify the prevalence of CPA among CPTB. Method: Five provinces with the highest clinical tuberculosis cases in the Northern area were selected. The clinical data of clinical TB patients receiving TB treatment were reviewed and assessed. Enrolled patients have been tested for CPA. Results: 77 CPTB patients with either negative results with Gene Xpert, MGIT culture, or smear were enrolled. 92% of patients were newly diagnosed with TB. The ratio between males and females is 3:1. The percentage of patients with at least one comorbidity disease (either COPD, DM, Hepatitis, NTM, asthma,.) was 24,7%. Around 5.2% of clinical cases has CPA-positive with IgG test (with cut off 1.0 and index range 1.21 to 3.82). Interestingly, those whose IgG was positive are all newly diagnosed with TB. Most CPA cases did not have suspected TB symptoms either cough, productive cough, or dyspnea. One among them had COPD. Regarding radiographic abnormality, two among four cases had diffused tram-track signs and small nodules, likely bronchiectasis. The two others had suspected a cavity in the right upper lobe. Conclusions: Four identified cases didn't fully meet the CPA case definition following ERS guideline 2016. However, Vietnam National Tuberculosis Program will need more attention in screening CPA among suspected clinical TB cases to avoid unnecessary TB treatment.