Risk Factors and Long‐Term Prognosis for Coinfection of Nontuberculous Mycobacterial Pulmonary Disease and Chronic Pulmonary Aspergillosis: A Multicentre Observational Study in Japan

PMCID: PMC12178108

PMID: 40536274

DOI: 10.1111/myc.70083

Journal: Mycoses

Publication Date: 2025-6-19

Authors: Tanaka Y, Ide S, Takazono T, Takeda K, Iwanaga N, et al.

Key Points

• CPA coinfection occurs in 3.5% of NTM-PD patients, with Aspergillus fumigatus being the most common causative species
• Male sex, COPD, oral corticosteroids, and cavity formation are independent risk factors for CPA coinfection
• Clinicians should carefully monitor NTM-PD patients with identified risk factors for potential CPA development and its impact on long-term prognosis

Summary

This multicentre, retrospective cohort study investigated the epidemiology and clinical implications of chronic pulmonary aspergillosis (CPA) coinfection in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) across 18 hospitals in Japan. Among 1,304 NTM-PD patients, 45 (3.5%) were diagnosed with CPA, with Mycobacterium intracellulare and Aspergillus fumigatus being the predominant species. The study comprehensively examined the risk factors, diagnostic challenges, and long-term prognostic impact of CPA coinfection.

The research identified key risk factors for CPA coinfection, including male sex, chronic obstructive pulmonary disease (COPD), oral corticosteroid use, and cavity formation. Critically, the study demonstrated that CPA coinfection was an independent poor prognostic factor, with significantly higher all-cause mortality compared to NTM-PD patients without CPA (55.6% vs. 15.3%, log-rank test p < 0.001). After propensity score matching, CPA remained associated with increased mortality (adjusted hazard ratio 1.59), underscoring the importance of vigilant monitoring and early intervention in high-risk patients.