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

Mycoses. 2021 Jul;64(7):788-793. doi: 10.1111/myc.13284. Epub 2021 Apr 24.

Abstract

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.

Keywords: Aspergillus IgG; CPA; PTB; PTBLD; chronic pulmonary aspergillosis; haemoptysis; scoring; x-ray.

MeSH terms

  • Aspergillus / immunology
  • Chronic Disease
  • Humans
  • Immunoglobulin G / blood
  • Lung / diagnostic imaging*
  • Lung / microbiology
  • Lung / pathology
  • Organ Dysfunction Scores
  • Pulmonary Aspergillosis / diagnosis*
  • Radiography / methods
  • Tuberculosis, Pulmonary / complications
  • X-Rays

Substances

  • Immunoglobulin G