Researchers complete first phase of landmark study on fungal complications of TB

The first phase of a landmark study of complications of tuberculosis (TB) - the first ever carried out in Africa - has been completed by researchers at Wythenshawe Hospital and the University of Manchester working with colleagues in Uganda. They believe that their results have important implications for better understanding a disease that kills three people every minute and affects 8.7 million worldwide annually.

TB remains one of the world’s most common serious diseases, and the World Health Organisation (WHO) has declared TB a global health emergency. Britain is now the only nation in Western Europe with rising levels of TB, and last year more than 9,000 cases were diagnosed.

Simple and effective drug treatment has been available for decades and millions of people have been successfully cured of the condition. Despite this treatment, many patients sadly suffer a recurrence of their symptoms and often die despite re-starting tuberculosis drugs.

Research in the 1960s showed that some patients developed a fungal lung disease called chronic pulmonary aspergillosis (CPA) after being cured of TB. This condition causes progressive breathlessness and death, but the disease can be stabilised and often improved with the drug, Itraconazole. Surgery can provide a complete cure in some cases. 

Although most cases occur in Africa, no survey has ever been carried out in Africa to determine if CPA is present there. But, after recruiting 400 patients in Uganda, the team has found that 15 per cent of these patients have symptoms and X-ray changes consistent with CPA. If correct this would suggest over a million people have the condition worldwide. Blood tests are now being conducted to confirm the presence of the disease. 

This research has been conducted in collaboration with Gulu University, in northern Uganda. Gulu was at the centre of the decades-long insurgency led by Joseph Kony’s Lord’s Resistance Army. Gulu Medical School was set up after the conflict ended in 2005 and has been supported throughout by the University of Manchester and UHSM Academy via the Gulu-Man link. This is the first major piece of research to be conducted in Gulu and represents a landmark in the development of its medical school. 

Dr Iain Page, who leads the study, is a Clinical Fellow at the National Aspergillosis Centre, based at Wythenshawe Hospital. He explains: “CPA is potentially a very serious problem on a global scale. Here at the National Aspergillosis Centre we treat over 200 patients, and we know that with treatment they can remain stable and expect a good quality of life. It’s very important for us to know how common this condition is.”

Professor David Denning, who is Director of the National Aspergillosis Centre and Professor of Infectious Diseases and Global Health, adds: “We think CPA is likely to be a common complication of TB. It should be entirely possible to deliver effective treatment, even in resource-poor countries in Africa. Proving the disease exists in Africa is the first, crucial step on the path to saving millions of lives. Blood samples have been shipped to Manchester, and testing for antibodies to aspergillus will commence soon.” 

Professor Ged Byrne, who is Professor of Medical Education and Director of UHSM Academy, explains that assisting in the establishment of Gulu Medical School has been an important part of the work of the Academy over the last seven years. “Gulu suffered massively as a result of conflict and the progress at the Medical School has been fantastic. Completion of recruitment for the first major research project at Gulu Medical School is a real landmark in its development and one we are really proud to have played our part.”