Concurrence of active mycobacterium tuberculosis and aspergilloma in patients who underwent lobectomies at Charlotte Maxeke Johannesburg Academic Hospital from 2000-2016

Abstract

Introduction: South Africa has a high prevalence of pulmonary tuberculosis (PTB). Clinicians are often faced with a myriad of complications that arise following PTB, one of which of life-threatening or recurrent haemoptysis as a result of aspergilloma, sometimes requiring lobectomy. Methods: We reviewed the demographics, and the concurrence of aspergilloma and active tuberculosis in patients undergoing lobectomies for suspected aspergilloma at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 2000 and 2016. Results: There were 121 patients in this study, of which 62.8% were male, 49% above 42 years and 47% between ages of 25 to 42 years. There was a history of previous pulmonary tuberculosis in 66.9% of the cohort, and of these, 28% had evidence of previous positive smear microscopy, 18% were culture positive, and 1.65% of patients in the cohort had positive sputum Xpert MTB/RIF test. Patients with active PTB on histology formed 30% of the cohort, and 70% had sequelae of PTB. Multivariate analysis showed a history of previous TB and HIV positivity or unknown HIV status to be risk factors for active TB. More than half the cohort, (54%) were HIV positive, which is more than four times the national prevalence (13%). The median CD4+ count was 250 cell/mm3. Aspergillus species was found histologically in 81% of cases. There was no positive sputum culture of Aspergillus species. Conclusions: Although the sample size is small, this study was able to show that a history of previous PTB, and HIV positivity are risk factors for the development of active TB in this cohort. We were unable to determine a statistically significant association between active TB and aspergilloma and therefore cannot recommend empiric TB treatment for patients with massive haemoptysis, There is a need further investigation into this subject matter