Clinical Features and Mortality of Chronic Pulmonary Aspergillosis in Brazil: a Multicenter Cohort Study

TL;DR

This study examines the clinical features and mortality of chronic pulmonary aspergillosis in Brazil, finding that tuberculosis is linked to lower mortality.

Contribution

The study provides new insights into CPA in a high TB-burden, resource-limited setting like Brazil.

Findings

Tuberculosis was independently associated with lower mortality in CPA patients.

Patients with TB had more hemoptysis and greater radiological involvement.

One-year mortality was 6%, lower than previously reported in similar settings.

Abstract

Data on clinical characteristics and prognosis of chronic pulmonary aspergillosis (CPA) in resource-limited, high tuberculosis (TB) burden settings, especially in Brazil, remain scarce.

This multicenter retrospective study evaluated all CPA cases diagnosed between 2012 and 2018 across eight centers in Brazil, examining clinical presentation, diagnosis, treatment, mortality, and factors associated with death, including differences related to pulmonary TB. To identify independent predictors of mortality, we conducted multivariate Cox regression. One-year mortality was analyzed using Kaplan–Meier survival curves.

A total of 191 CPA cases were diagnosed, with a median age of 50 years (IQR 40–59) and 62% were male. TB was the most frequent predisposing condition (n = 138, 72%). Most patients (80%) received antifungal therapy, primarily itraconazole (n = 140, 73%). Surgery was performed in 34% of cases. According to Kaplan–Meier analysis, the cumulative mortality at 12 months was 6%. Compared to survivors, nonsurvivors had significantly lower rates of TB (52% vs 77%, P = .019) and higher rates of malignancies (13% vs 3%, P = .033). In multivariate analysis, only TB was independently associated with lower mortality (HR 0.413, 95% CI: .179–.954, P = .038). The TB group showed more hemoptysis (P = .008) and greater radiological involvement, suggesting delayed diagnosis.

In Brazil, the mortality of CPA was lower compared with that reported in previous studies, particularly among patients with TB. In TB-endemic, resource-limited settings, overlapping clinical and radiological features may delay diagnosis and antifungal treatment.

Tuberculosis was independently associated with lower mortality in patients with chronic pulmonary aspergillosis in Brazil.

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