Clinical impact of chronic pulmonary aspergillosis in patients with pulmonary nontuberculous mycobacterial disease and colonization: a multicentre prospective cohort study.
Journal
Annals of medicine
Journal Volume
58
Journal Issue
1
Start Page
Article number 2634439
ISSN
1365-2060
Date Issued
2026-12
Author(s)
Wu, Chang-Wei
Huang, Hung-Ling
Cheng, Meng-Hsuan
Sheu, Chau-Chyun
Chong, Inn-Wen
Abstract
Background: Pulmonary nontuberculous mycobacterial (NTM) infection and chronic pulmonary aspergillosis (CPA) are interconnected diseases, but their relationship remains poorly understood. Materials and methods: In this prospective, multi-centre study conducted in Taiwan between August 2020 and January 2024, 365 patients with cultures positive for Mycobacterium avium complex, Mycobacterium kansasii, or Mycobacterium abscessus complex were followed until August 2024. Serum Aspergillus-specific IgG levels were measured at baseline and follow-up. Results: Among these patients, 123 (33.7%) tested positive for Aspergillus-specific IgG (>40 mgA/L), and 33 (9.0%) were diagnosed with CPA (10 at initial diagnosis, 23 developed CPA during a median follow-up of 18 months). Patients with NTM pulmonary disease (NTM-PD) demonstrated significantly higher cumulative incidence of CPA compared to those with NTM pulmonary colonization (NTM-PC) (2.7%, 8.3%, and 14.7% vs. 0%, 2.9%, and 5.3% at 1, 2, and 3 years, respectively; p = 0.0408). CPA development was linked to worse overall survival (adjusted hazard ratio [aHR] 3.96, 95% confidence interval [CI]: 1.47–10.69, p = 0.0066) as well as higher risk of radiographic progression (adjusted odds ratio [aOR] 7.43, 95% CI: 2.17–32.11, p = 0.0030). Longitudinal assessment of Aspergillus-specific IgG in 119 patients showed nine with positive seroconversion, and two were subsequently diagnosed with CPA. Conclusions: These findings indicate that approximately one-third of pulmonary NTM isolation patients have elevated Aspergillus-specific IgG, about 10% develop CPA, and CPA development is associated with poor survival. Therefore, longitudinal monitoring of Aspergillus-specific IgG is warranted to facilitate early detection and management of CPA in patients with pulmonary NTM isolation.
Subjects
Aspergillus-specific IgG
Nontuberculous mycobacteria
chronic pulmonary aspergillosis
diagnosis
outcome
Type
journal article