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 UHSM (University Hospital South Manchester) 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.

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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.

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Manchester Evening News article

Manchester Evening News feature

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 UHSM. 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.

For more information please contact Susan Osborne, Director of Communications, the Goodwork Organisation on 07836 229208.

Notes to Editors

Dr Iain Page recruited 400 adult patients who were previously treated for tuberculosis in Gulu, Northern Uganda. Half of those recruited were also suffering from HIV infection. Recruitment took place between September 2012 and February 2013. In order to be diagnosed with CPA patients must have symptoms and X-ray changes and antibodies to aspergillus in the blood. 59 per cent of patients have chronic symptoms consistent with aspergillosis and 24 per cent had chest X-ray changes consistent with aspergillosis. 15 per cent had both symptoms and X-ray changes and so might be suffering from CPA.

The results of this survey will be presented at the 6th Trends in Medical Mycology conference in Copenhagen, the 43rd Union World Conference on Lung Health in Paris and the 6th Advances Against Aspergillus conference in Madrid, in February 2014.

Globally, TB is a leading cause of death from an infectious disease worldwide, second only to AIDS. It is also known as a disease of poverty, affecting mainly young adults in their most productive years, with two-thirds of cases estimated to occur among people aged 15-59. In 2011 there were 8.7 million new cases of TB and 1.4 million deaths (this includes 430,000 deaths among people who were HIV-positive). The vast majority of deaths from TB –over 95 per cent – are in the developing world.

University Hospital of South Manchester NHS Foundation Trust (UHSM) is a major acute teaching hospital trust providing services for almost 750,000 adults and children at Wythenshawe Hospital and Withington Community Hospital. UHSM is recognised as a centre of excellence in cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, cancer and breast care services drawing patients from across the North of England and beyond. UHSM also provide a full range of district general services to local communities in and around South Manchester.