Chronic Pulmonary Aspergillosis in Nontuberculous Mycobacterial Lung Disease: Prevalence, Risk Factors, and Impact on Clinical Outcome

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Background: Pulmonary nontuberculous mycobacteria (NTM) and chronic pulmonary aspergillosis (CPA) often coexist, but their relationship remains unclear. This study explored the prevalence of elevated Aspergillus IgG, CPA, and their effects on pulmonary NTM patients. Methods: Between June 2019 and February 2022, a prospective multicenter study included patients with respiratory specimens positive for Mycobacterium avium complex (MAC), M. kansasii, or M. abscessus complex from three Taiwanese medical centers. Aspergillus IgG levels were measured at baseline and follow-up. The primary endpoint was overall survival, and the secondary was radiographic progression. Results: Among 365 patients (234 with NTM lung disease [NTM-LD] and 131 with NTM lung colonization [NTM-LC]), 123 (33.7%) exhibited elevated Aspergillus-specific IgG levels (>40 mgA/L), and 33 (9.0%) were diagnosed with CPA. Factors linked to CPA included high Aspergillus-specific IgG titers, higher BMI, inhaled corticosteroid use, and active cancer. Multivariable analysis indicated that CPA was associated with reduced overall survival (hazard ratio [HR]: 4.80, 95% confidence interval [CI]: 1.36–17.0, p=0.015) and an increased likelihood of radiographic progression (odds ratio [OR]: 3.98, 95% CI: 1.23–12.9, p=0.0214). Among 119 patients monitored longitudinally, 9 with initially negative Aspergillus IgG levels converted to positive, and 3 of these patients subsequently developed CPA. Conclusions: CPA complicates pulmonary NTM and worsens outcomes. Monitoring Aspergillus-specific IgG can support early detection and intervention for CPA in NTM patients.

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