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Association between allergic bronchopulmonary aspergillosis or Aspergillus sensitization and tuberculosis: A
Anuj Ajayababu1, Martin Hoenigl2, Animesh Ray1
1Department of Medicine, AIIMS, New Delhi, India.
Introduction:
Although allergic bronchopulmonary aspergillosis (ABPA) is classically described in asthma and cystic fibrosis, pulmonary tuberculosis (PTB) with post-tubercular lung disease (PTLD) has been reported as a likely predisposing factor. It, however, has not been reviewed systematically, which we aimed to achieve in the current systematic review.
Methods:
We screened the available literature from PubMed, Embase, SCOPUS and Web of Science databases for studies reporting association between ABPA and PTB from the beginning of time to June 30, 2023 and collated the data on association of ABPA and tuberculosis.
Results:
1176 articles were identified from the initial search, of which 60 articles (27 original articles and 33 case reports) were included in the final analysis. Four patterns were described: ABPA in patients with previous TB (151, 24.9 %), co-existent ABPA and TB (16, 2.6 %), Aspergillus sensitization in patients with prior or current TB (91, ∼15 %) and ABPA misdiagnosed as TB (349, 57.5 %). There was significant heterogeneity in the diagnostic criteria used for ABPA and pulmonary TB. From limited individual data, which could be extracted, observations were: 1) Central bronchiectasis (32.6 %), cavity (22.8 %), fungal ball (12.0 %), mucus plug/high attenuation mucus (HAM) (7.6 %) and consolidation/centrilobular nodules (12.0 %) were the most common radiographic abnormalities. 2) 96.4 % received steroids, 11 % received antifungals mostly for relapse or inadequate response. 3) Adequate treatment response was noted in the limited cohort where it was reported.
Conclusions:
ABPA is commonly misdiagnosed as TB, but Aspergillus sensitization/ABPA can develop in patients with prior TB. However, significant heterogeneity in diagnostic criteria limits generalizability. Future well-designed prospective studies are required to confirm these associations.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) is often misdiagnosed as tuberculosis (TB), but it can also develop in patients with prior TB. Further research is needed due to varied diagnostic criteria.
Area of Science:
- Pulmonology
- Infectious Diseases
- Allergy & Immunology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is typically associated with asthma and cystic fibrosis.
- Pulmonary tuberculosis (PTB) and its sequelae (post-tubercular lung disease) are increasingly recognized as potential predisposing factors for ABPA.
- A systematic review is needed to consolidate existing evidence on the association between ABPA and tuberculosis.
Purpose of the Study:
- To systematically review the literature on the association between allergic bronchopulmonary aspergillosis (ABPA) and tuberculosis (TB).
- To identify patterns of ABPA in patients with current or prior TB, and vice versa.
- To analyze radiographic findings, treatment patterns, and outcomes in cases of ABPA and TB co-occurrence or misdiagnosis.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Embase, SCOPUS, and Web of Science databases.
- Studies reporting an association between ABPA and PTB were screened and data were collated.
- The search included literature from the earliest available records up to June 30, 2023.
Main Results:
- Out of 1176 identified articles, 60 were included, revealing four patterns: ABPA in patients with prior TB (24.9%), co-existent ABPA and TB (2.6%), Aspergillus sensitization with TB (15%), and ABPA misdiagnosed as TB (57.5%).
- Common radiographic findings included central bronchiectasis, cavities, fungal balls, mucus plugs/high attenuation mucus, and consolidation.
- Most patients received steroids (96.4%), with antifungals used in 11% for relapses or inadequate response.
Conclusions:
- Allergic bronchopulmonary aspergillosis (ABPA) is frequently misdiagnosed as tuberculosis (TB).
- Aspergillus sensitization or ABPA can develop in individuals with a history of TB.
- Significant heterogeneity in diagnostic criteria hinders generalizability, necessitating well-designed prospective studies.
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