A retrospective analysis of chronic pulmonary aspergillosis (CPA) patients has demonstrated the presence of Aspergillus sensitisation and a higher Aspergillus-specific IgG titre at completion of antifungal treatment as predictors of relapse. Contrastingly, no significant association was found between relapse and underlying lung conditions such as chronic obstructive pulmonary disease or prior TB.
This finding will be of real benefit in identifying patients who will require more frequent or more prolonged follow-up after treatment. In addition, it also suggests that the fungal burden in the airways as a more important determinant of CPA relapse than associated comorbidities or underlying disease conditions in an index host. However, as more frequent relapse in patients with prior tuberculosis (TB) was observed (9 relapse cases amongst 23 (39%) patients with a prior history of TB), the authors suggest a further analysis with a larger sample size may identify a significant association between this risk factor and relapse.
The study enrolled 125 adult patients who had received at least 6 months of azole treatment for CPA at the National Aspergillosis Centre, Manchester, and were deemed by the treating clinician not to require further antifungal treatment for CPA at that point. Patients who were switched from one antifungal agent to another, due to intolerance or resistance, were also included, provided the treatment gap between the antifungal agents was <6 weeks. Of the 125, thirty-two (26%) patients had a relapse. Among 100 patients who had follow-up data for more than 12 months, 16 (16%) had an early relapse (within a year after completing the antifungal treatment).
Clinically, relapse can be subtle, with minimal worsening of symptoms, but significant radiological or lung function changes. Follow-up, therefore, needs to encompass imaging, Aspergillus IgG titre, lung fungal and sputum fungal culture.
