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A Systematic Review of Chronic Pulmonary Aspergillosis Among Patients Treated for Pulmonary Tuberculosis

Alicia Madden1, Sylvia K Ofori2, Marian Budu3

  • 1Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 21, 2025
PubMed
Abstract

Insights

Chronic pulmonary aspergillosis (CPA) affects 9-13% of tuberculosis (TB) patients, rising to 48% in those with persistent symptoms post-treatment. Routine screening for CPA in TB programs is recommended.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Mycology

Background:

  • Tuberculosis (TB) is a significant global health issue with lasting complications.
  • Chronic pulmonary aspergillosis (CPA) frequently affects TB survivors, contributing to post-TB lung disease (PTLD).
  • The prevalence of CPA in TB patients is underestimated due to diagnostic challenges.

Purpose of the Study:

  • To estimate the prevalence of CPA in patients with prior or concurrent TB.
  • To identify factors influencing the burden of CPA in TB patients.

Main Methods:

  • Systematic literature search of PubMed, Cochrane Library, Web of Science, and Science Direct up to 1/10/2025.
  • Meta-analysis of 22 eligible cohort and cross-sectional studies (2,884 patients) using a random-effects model.
  • Subgroup and meta-regression analyses to explore predictors of CPA prevalence.

Main Results:

  • Overall CPA prevalence was 9% (95% CI: 6%, 12%) during TB treatment and 13% (95% CI: 6%, 27%) post-treatment.
  • Among TB patients with persistent respiratory symptoms, CPA prevalence was 20% during treatment and 48% (95% CI: 36%, 61%) post-treatment.
  • Symptom status and timing of assessment significantly predicted CPA prevalence.

Conclusions:

  • A substantial burden of CPA exists among TB survivors, especially those with persistent symptoms.
  • Routine screening for CPA in TB programs is warranted.
  • Early detection and intervention can mitigate respiratory complications and improve outcomes for TB patients.
Keywords:
chronic pulmonary aspergillosispost-tuberculosis lung diseaseprevalencesystematic reviewtuberculosis

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