TY - JOUR T1 - A prospective longitudinal study of chronic pulmonary aspergillosis in pulmonary tuberculosis in Indonesia (APICAL) JF - Thorax JO - Thorax SP - 821 LP - 828 DO - 10.1136/thoraxjnl-2020-216464 VL - 77 IS - 8 AU - Findra Setianingrum AU - Anna Rozaliyani AU - Robiatul Adawiyah AU - Ridhawati Syam AU - Mulyati Tugiran AU - Cut Yulia Indah Sari AU - Finny Nandipinto AU - Johannes Ramnath AU - Arief Riadi Arifin AU - Diah Handayani AU - Erlina Burhan AU - Martin Rumende AU - Retno Wahyuningsih AU - Riina Rautemaa-Richardson AU - David W Denning Y1 - 2022/08/01 UR - http://thorax.bmj.com/content/77/8/821.abstract N2 - Objectives Chronic pulmonary aspergillosis (CPA) can complicate recovery from pulmonary TB. CPA may also be misdiagnosed as bacteriologically negative TB. This study aimed to determine the incidence of CPA in patients treated for TB in Indonesia, a country with a high incidence of TB.Methods In this prospective, longitudinal cohort study in patients treated for pulmonary TB, clinical, radiological and laboratory findings were analysed. Sputum was collected for fungal culture and TB PCR. Patients were assessed at baseline (0–8 weeks) and at the end (5–6 months) of TB therapy. CPA diagnosis was based on symptoms (≥3 months), characteristic radiological features and positive Aspergillus serology, and categorised as proven, probable and possible.Results Of the 216 patients recruited, 128 (59%) were followed up until end of TB therapy. At baseline, 91 (42%) had microbiological evidence for TB. Aspergillus-specific IgG was positive in 64 (30%) patients and went from negative to positive in 16 (13%) patients during TB therapy. The incidence rates of proven and probable CPA at baseline were 6% (n=12) and 2% (n=5) and end of TB therapy 8% (n=10) and 5% (n=7), respectively. Six patients (two with confirmed TB) developed an aspergilloma. Diabetes mellitus was a significant risk factor for CPA (p=0.040). Persistent cough (n=5, 50%; p=0.005) and fatigue (n=6, 60%; p=0.001) were the most common symptoms in CPA.Conclusion CPA should be considered a relatively frequent differential diagnosis in patients with possible or proven TB in Indonesia. Lack of awareness and limited access to Aspergillus-specific IgG tests and CT imaging are obstacles in establishing a CPA diagnosis.Data are available upon reasonable request. All data are available if requested. ER -