4.5 Article

A simple x-ray scoring system for the diagnosis of chronic pulmonary aspergillosis

Journal

MYCOSES
Volume 64, Issue 7, Pages 788-793

Publisher

WILEY
DOI: 10.1111/myc.13284

Keywords

Aspergillus IgG; chronic pulmonary aspergillosis; CPA; haemoptysis; PTB; PTBLD; scoring; x‐ ray

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This study evaluated an X-ray scoring system as a marker for lung damage in patients with PTBLD presenting with haemoptysis and its utility to predict Aspergillus serum IgG levels.
Background Chronic pulmonary aspergillosis (CPA) is a severe form of post-tuberculosis lung disease (PTBLD). Considering the high burden of TB in India, it can be concluded that the prevalence of CPA is also high. Chest x-ray though most feasible, interpretation is subjective. Therefore, decision on evaluation for CPA cannot be based on x-ray alone. Objective Present study evaluated an x-ray score as a marker for extent of lung damage in patients with PTBLD presenting with haemoptysis and its utility to predict Aspergillus serum IgG levels. Methods We used a modified scoring system developed by Anna Ralph et al X-ray score cut-offs of >71 and 40, with or without history of massive haemoptysis, were compared with serum IgG levels. Results With a chest x-ray score cut-off of 71, specificity was 88%. With an x-ray score of >71 combined with history of massive haemoptysis, 86% cases were found to be IgG positive. The specificity of this combination was 96%. Conclusion This study concluded that a simple chest x-ray scoring system in addition to the symptom of massive haemoptysis helped in the decision on further evaluation of the subject for CPA, especially in resource constrained settings.

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