{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T15:37:23Z","timestamp":1789227443649,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T00:00:00Z","timestamp":1607385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Chronic pulmonary aspergillosis (CPA) following nontuberculous mycobacterial (NTM) lung disease is being increasingly recognized, especially in countries where tuberculosis is not endemic, with an incidence rate of 3.9\u201316.7%. NTM lung disease has been identified as a predictor of mortality in CPA patients. The major risk factors for NTM-associated CPA include fibrocavitary NTM lung disease, the presence of pulmonary emphysema, and high-dose corticosteroid use. The onset of CPA is 1.5\u20137 years following the diagnosis of NTM lung disease. The diagnosis can be made using standard criteria; however, serological diagnosis using Aspergillus precipitin has demonstrated a higher sensitivity and specificity when compared with fungal culture from respiratory specimens. Treatment is challenging since rifampicin and oral triazoles should not be used concomitantly. The prognosis is poor, and the factors associated with worse prognosis are corticosteroid use and high C-reactive protein level.<\/jats:p>","DOI":"10.3390\/jof6040346","type":"journal-article","created":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T09:17:04Z","timestamp":1607419024000},"page":"346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Chronic Pulmonary Aspergillosis Following Nontuberculous Mycobacterial Infections: An Emerging Disease"],"prefix":"10.3390","volume":"6","author":[{"given":"Pakpoom","family":"Phoompoung","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4582-4914","authenticated-orcid":false,"given":"Methee","family":"Chayakulkeeree","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1080\/23744235.2016.1232861","article-title":"Chronic fibrosing pulmonary aspergillosis: A cause of \u2018destroyed lung\u2019 syndrome","volume":"49","author":"Kosmidis","year":"2017","journal-title":"Infect. Dis. (Lond.)"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hayes, G.E., and Novak-Frazer, L. (2016). Chronic Pulmonary Aspergillosis-Where Are We? and Where Are We Going?. J. Fungi, 2.","DOI":"10.3390\/jof2020018"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1183\/13993003.00583-2015","article-title":"Chronic pulmonary aspergillosis: Rationale and clinical guidelines for diagnosis and management","volume":"47","author":"Denning","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"864","DOI":"10.2471\/BLT.11.089441","article-title":"Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis","volume":"89","author":"Denning","year":"2011","journal-title":"Bull. World Health Organ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1801184","DOI":"10.1183\/13993003.01184-2018","article-title":"Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation","volume":"53","author":"Page","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s10096-015-2409-7","article-title":"Prevalence of chronic pulmonary aspergillosis in patients with tuberculosis from Iran","volume":"34","author":"Hedayati","year":"2015","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bongomin, F. (2020). Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern. PLoS Pathog., 16.","DOI":"10.1371\/journal.ppat.1008742"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e479","DOI":"10.1016\/j.ijid.2009.07.011","article-title":"Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: A review of 43 cases","volume":"14","author":"Nam","year":"2010","journal-title":"Int. J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1183\/09031936.00054810","article-title":"Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma","volume":"37","author":"Smith","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3389\/fimmu.2020.00303","article-title":"The Rise of Non-Tuberculosis Mycobacterial Lung Disease","volume":"11","author":"Ratnatunga","year":"2020","journal-title":"Front Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1111\/resp.12287","article-title":"Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis","volume":"19","author":"Zoumot","year":"2014","journal-title":"Respirology"},{"key":"ref_12","first-page":"781","article-title":"[Clinical analysis of non-tuberculous mycobacteriosis cases complicated with pulmonary aspergillosis]","volume":"86","author":"Ishikawa","year":"2011","journal-title":"Kekkaku"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1136\/thx.52.9.810","article-title":"Surgical treatment for pulmonary aspergilloma: A 28 year experience","volume":"52","author":"Chen","year":"1997","journal-title":"Thorax"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"342","DOI":"10.4103\/0377-4929.42507","article-title":"Pathology of pulmonary aspergillomas","volume":"51","author":"Shah","year":"2008","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1001\/archinte.1985.00360120048007","article-title":"Pulmonary mycetoma following Mycobacterium kansasii infection. Report of seven cases","volume":"145","author":"Maliwan","year":"1985","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1136\/thx.49.5.521","article-title":"Pulmonary Mycobacterium malmoense and aspergillus infection: A fatal combination?","volume":"49","author":"Bollert","year":"1994","journal-title":"Thorax"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/0041-3879(88)90077-3","article-title":"Mycobacterium xenopi infection and aspergilloma","volume":"69","author":"Johnston","year":"1988","journal-title":"Tubercle"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1136\/thorax.55.8.717","article-title":"Non-tuberculous mycobacterial lung infection complicated by chronic necrotising pulmonary aspergillosis","volume":"55","author":"Hafeez","year":"2000","journal-title":"Thorax"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1183\/09031936.06.00139005","article-title":"Nontuberculous mycobacterial disease and Aspergillus-related lung disease in bronchiectasis","volume":"28","author":"Kunst","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ccm.2014.11.002","article-title":"Nontuberculous mycobacteria infections in immunosuppressed hosts","volume":"36","author":"Henkle","year":"2015","journal-title":"Clin. Chest Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1183\/09031936.06.00149805","article-title":"Nontuberculous mycobacteria in bronchiectasis: Prevalence and patient characteristics","volume":"28","author":"Fowler","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"676","DOI":"10.5588\/ijtld.12.0684","article-title":"Isolation of non-tuberculous mycobacteria among patients with pulmonary tuberculosis in Ontario, Canada","volume":"17","author":"Damaraju","year":"2013","journal-title":"Int. J. Tuberc. Lung. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1093\/mmy\/myv093","article-title":"The risk factors for developing of chronic pulmonary aspergillosis in nontuberculous mycobacteria patients and clinical characteristics and outcomes in chronic pulmonary aspergillosis patients coinfected with nontuberculous mycobacteria","volume":"54","author":"Takeda","year":"2016","journal-title":"Med. Mycol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/j.jiac.2018.04.002","article-title":"Risk stratification for the development of chronic pulmonary aspergillosis in patients with Mycobacterium avium complex lung disease","volume":"24","author":"Furuuchi","year":"2018","journal-title":"J. Infect. Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"105955","DOI":"10.1016\/j.rmed.2020.105955","article-title":"Impact of Aspergillus precipitating antibody test results on clinical outcomes of patients with Mycobacterium avium complex lung disease","volume":"166","author":"Shirai","year":"2020","journal-title":"Respir. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Jhun, B.W., Jung, W.J., Hwang, N.Y., Park, H.Y., Jeon, K., and Kang, E.S. (2017). Risk factors for the development of chronic pulmonary aspergillosis in patients with nontuberculous mycobacterial lung disease. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0188716"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1016\/S0140-6736(03)14904-5","article-title":"Glucocorticoids and invasive fungal infections","volume":"362","author":"Lionakis","year":"2003","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1099\/13500872-140-9-2475","article-title":"Hydrocortisone-enhanced growth of Aspergillus spp.: Implications for pathogenesis","volume":"140","author":"Ng","year":"1994","journal-title":"Microbiology (Read.)"},{"key":"ref_29","first-page":"R191","article-title":"Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: Risk factors, clinical presentation and outcome","volume":"9","author":"Leon","year":"2005","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/j.1440-1843.2006.00952.x","article-title":"Chronic necrotizing pulmonary aspergillosis as a complication of pulmonary Mycobacterium avium complex disease","volume":"11","author":"Kobashi","year":"2006","journal-title":"Respirology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s10096-017-3105-6","article-title":"Clinical significance of Aspergillus species isolated from respiratory specimens in patients with Mycobacterium avium complex lung disease","volume":"37","author":"Furuuchi","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.3201\/eid2206.151086","article-title":"Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease, Japan","volume":"22","author":"Namkoong","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"16300","DOI":"10.1038\/s41598-017-16559-z","article-title":"Epidemiology and Predictors of NTM Pulmonary Infection in Taiwan-a Retrospective, Five-Year Multicenter Study","volume":"7","author":"Huang","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.rmed.2019.05.001","article-title":"Interrelational changes in the epidemiology and clinical features of nontuberculous mycobacterial pulmonary disease and tuberculosis in a referral hospital in Japan","volume":"152","author":"Furuuchi","year":"2019","journal-title":"Respir. Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Lim, A.Y.H., Chotirmall, S.H., Fok, E.T.K., Verma, A., De, P.P., and Goh, S.K. (2018). Profiling non-tuberculous mycobacteria in an Asian setting: Characteristics and clinical outcomes of hospitalized patients in Singapore. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-018-0637-1"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Phoompoung, P., Ankasekwinai, N., Pithukpakorn, M., Foongladda, S., Umrod, P., and Suktitipat, B. (2017). Factors associated with acquired Anti IFN- gamma autoantibody in patients with nontuberculous mycobacterial infection. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0176342"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2980","DOI":"10.3389\/fmicb.2019.02980","article-title":"Concomitant Presence of Aspergillus Species and Mycobacterium Species in the Respiratory Tract of Patients: Underestimated Co-occurrence?","volume":"10","author":"Delliere","year":"2019","journal-title":"Front Microbiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1128\/CMR.00055-08","article-title":"Pathogenesis of Aspergillus fumigatus in Invasive Aspergillosis","volume":"22","author":"Dagenais","year":"2009","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1093\/clinids\/18.2.266","article-title":"Coadministration of rifampin and itraconazole leads to undetectable levels of serum itraconazole","volume":"18","author":"Drayton","year":"1994","journal-title":"Clin. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1007\/s12281-017-0304-7","article-title":"The Management of Chronic Pulmonary Aspergillosis: The UK National Aspergillosis Centre Approach","volume":"11","author":"Maghrabi","year":"2017","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.jinf.2010.08.005","article-title":"Intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis: A multicenter trial in Japan","volume":"61","author":"Kohno","year":"2010","journal-title":"J. Infect."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s10096-012-1754-z","article-title":"A double-blind comparative study of the safety and efficacy of caspofungin versus micafungin in the treatment of candidiasis and aspergillosis","volume":"32","author":"Kohno","year":"2013","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Gintjee, T.J., Donnelley, M.A., and Thompson, G.R. (2020). Aspiring Antifungals: Review of Current Antifungal Pipeline Developments. J. Fungi, 6.","DOI":"10.3390\/jof6010028"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1128\/AAC.04075-14","article-title":"Effect of rifampin and rifabutin on serum itraconazole levels in patients with chronic pulmonary aspergillosis and coexisting nontuberculous mycobacterial infection","volume":"59","author":"Moon","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciaa241","article-title":"Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS\/ERS\/ESCMID\/IDSA Clinical Practice Guideline: Executive Summary","volume":"71","author":"Daley","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2017-210927","article-title":"British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)","volume":"72","author":"Haworth","year":"2017","journal-title":"Thorax"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1136\/thx.50.2.216","article-title":"Pulmonary Mycobacterium malmoense and Aspergillus infection","volume":"50","author":"Debieuvre","year":"1995","journal-title":"Thorax"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Fukushima, K., Kitada, S., Abe, Y., Yamamoto, Y., Matsuki, T., and Kagawa, H. (2020). Long-Term Treatment Outcome of Progressive Mycobacterium Avium Complex Pulmonary Disease. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051315"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1601062","DOI":"10.1183\/13993003.01062-2016","article-title":"Predictors of mortality in chronic pulmonary aspergillosis","volume":"49","author":"Lowes","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.resinv.2018.04.002","article-title":"Prognosis of chronic pulmonary aspergillosis in patients with pulmonary non-tuberculous mycobacterial disease","volume":"56","author":"Naito","year":"2018","journal-title":"Respir. Investig."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/6\/4\/346\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:42:11Z","timestamp":1760179331000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/6\/4\/346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,8]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["jof6040346"],"URL":"https:\/\/doi.org\/10.3390\/jof6040346","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,8]]}}}