Martha Namusobya, MBChB
Nominated From: University of Minnesota
Research Site: Infectious Diseases Institute
Research Area: Tuberculosis
Primary Mentor: Christine Sekaggya-Wiltshire
Prevalence and Factors Associated with Chronic Pulmonary Aspergillosis (CPA) among Pulmonary Tuberculosis (PTB) Patients with persisting pulmonary symptoms in Uganda
TB is a risk factor for CPA, which is estimated to complicate 1.2 million cases of PTB worldwide; CPA global prevalence is 0.85 – 1.37 million . CPA is highly prevalent in high TB burden countries; a study in Nigeria found that 20% of PTB participants had positive Aspergillus culture growth and 8.2% positive Aspergillus-specific IgG antibodies. The TB burden in Uganda remains high with a prevalence of 253 per 100,000 population, thus predisposing many patients to the risk of developing CPA . There is limited data on the burden of CPA in Uganda where several studies have reported significantly elevated rates of Aspergillus-specific antibodies (6.4 – 47%) among TB patients, demonstrating a high level of exposure . However, it is not clear from these studies how many of these patients had active aspergillosis, using the recommended diagnostic criteria. In addition, there is limited data on the clinical outcomes of PTB patients with CPA. CPA may present with symptoms and a radiological picture similar to PTB, and therefore may be unrecognized and left untreated, leading to poor outcomes . Globally, up to 85% of patients with CPA in the general population die within 5 years of infection . Estimates based on these global figures reveal that in Uganda, mortality among TB patients with CPA co-infection is expected to be 15%, which translates into approximately 500 deaths per year. There is a need for empirical studies to quantify this burden and guide policy and decision making.
Although pulmonary symptoms may persist during and after TB treatment due to undetected fungal infection, routine screening for CPA is not performed. Undiagnosed CPA may negatively impact on quality of life after TB treatment, but can also result in death.
One million+ PTB patients develop CPA annually, 50% die within 5 years . CPA symptoms – weight loss, shortness of breath, fatigue and hemoptysis – are similar to PTB, which leads to delayed or missed diagnosis. Clinical symptoms of PTB should be alleviated after the intensive treatment phase (first 2 months) , however, they may persist during or after treatment due to co-existing CPA. To improve outcomes of co-infected individuals, symptom assessment and microbiological testing is needed to detect CPA early. However, screening for fungal infections is not part of PTB routine care due to paucity of data on their impact. This study will generate evidence on CPA burden among PTB patients, recommendations on screening for pulmonary fungal infections, thus ensuring early detection, treatment and reduction in mortality and morbidity.
Advice for Future Trainees
This fellowship is a once in a life time opportunity for junior researchers to launch themselves in the world of research, and do so in a holistic manner.
Never has a more all-round approach ever been presented me.
It is more than just a research fellowship. One is equipped with the research skills to go with it, mentorship, core competency lessons, program management training, readily available help from the program administrators, and close follow up on progress throughout the fellowship year.
This a path I hope any young and driven researcher finds themselves on, because for me, it was the gate that needed to be opened for my career to truly take off.