In News:

A recent study conducted by Assam Medical College and Hospital has revealed a high prevalence of Chronic Pulmonary Aspergillosis (CPA) among tuberculosis (TB) survivors in Assam’s tea garden communities. Published in the PLOS Neglected Tropical Diseases journal, the research underscores a significant public health concern in a region already burdened by TB.

What is Chronic Pulmonary Aspergillosis (CPA)?

• CPA is a severe, life-threatening fungal infection caused by Aspergillus fumigatus, a filamentous fungus commonly found in soil, decaying vegetation, and humid organic matter.
• It predominantly affects individuals with weakened immune systems or pre-existing lung conditions, especially those who have recovered from or are currently battling TB.
• CPA is not contagious and cannot be transmitted from person to person.

Symptoms and Clinical Presentation:

CPA shares many clinical features with TB, making diagnosis challenging:

• Chronic cough
• Haemoptysis (coughing up blood)
• Persistent respiratory symptoms
• Weight loss
• Fatigue
• Shortness of breath
• Wheezing

Key Findings from Assam:

• Study Area: Conducted in Dibrugarh district, covering tea workers and their dependents from four major tea estates.
• Sample Size: 128 patients with prolonged respiratory symptoms (>3 months).
• Prevalence:
  • CPA prevalence: 17.18% overall
  • Seropositivity in active TB patients: 18.5%
  • Seropositivity in post-TB patients: Spiked to 48.9%, indicating a strong link between CPA and previous TB infections.
• Demographic Insights:
  • Mean age: 41.9 years
  • Higher incidence among middle-aged male workers
• Comparison with Global Trends:
  • Assam’s CPA prevalence (60 per 1,00,000) exceeds the global average (42 per 1,00,000)
  • Worse than several African nations including Nigeria and the Democratic Republic of Congo (20–50 per 1,00,000)

Contributing Risk Factors in Assam’s Tea Belt:

• High TB burden: 217 per 1,00,000 (National TB Prevalence Survey 2019–2021)
• Poverty and malnutrition
• Kitchen smoke exposure
• Congested living conditions
• Delayed or inadequate TB treatment

Diagnosis and Treatment:

• Diagnosis:
  • Serological testing for Aspergillus antibodies
  • Radiological imaging to identify fungal growth in lung cavities
• Treatment:
  • Antifungal therapy (e.g., itraconazole or voriconazole)
  • Surgical removal in severe cases with fungal mass

Public Health Recommendations:

• Routine screening of post-TB patients for CPA in high-risk zones like tea estates
• Awareness campaigns targeting healthcare providers and workers to improve recognition and response
• Education on nutrition, respiratory hygiene, and early symptom detection
• Inclusion of fungal diseases like CPA in broader national TB and occupational health programs

Additional Context: Epidemic Dropsy in Assam’s Tea Belt

• A 2019 study had previously flagged the prevalence of epidemic dropsy, a condition caused by contaminated edible oils with Argemone mexicana oil, adding to the health risks in tea-growing regions.