Spectrum of Chronic Pulmonary Aspergillosis

Chronic pulmonary aspergillosis (CPA) encompasses all disease manifestations caused by Aspergillus in the lung that do not include invasive or allergic disease. It can range from a simple aspergilloma or Aspergillus nodule, which can be asymptomatic and stable, to debilitating progressive cavitary disease termed chronic cavitary pulmonary aspergillosis. Recognition is challenging due to lack of awareness among many clinicians and the nonspecific, indolent symptoms. Unlike invasive aspergillosis, CPA affects patients with underlying lung disease. Globally, the most common underlying condition is previously treated TB; the global burden of CPA is therefore substantial. In TB low-incidence areas, chronic obstructive pulmonary disease (COPD) is the most common predisposing condition. Overall, CPA is thought to arise in areas of existing structural lung disease such as cavitary, bronchiectatic or fibrotic areas that provide a niche to Aspergillus hyphae that can then proliferate locally. Symptoms include respiratory (cough, haemoptysis, and dyspnoea) or systemic (weight loss, fatigue, and malaise) and are present for at least 3 months. Aspergillus IgG and microbiological studies contribute to the diagnosis. A chest computed tomography (CT) scan is the imaging method of choice as it can delineate lesions better than an X-ray. Awareness of the condition is critical so the diagnosis is not missed.