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Clinical and diagnostic misperception of tuberculosis and systemic fungal infections

Karthikeyan Sundaram1, Sridhar Rathinam2, Venkataraman Prabhu3

  • 1Department of Herbal Pharmacology and Environmental Sustainability, Chettinad hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India.

Journal De Mycologie Medicale
|February 4, 2026
PubMed

Insights

Tuberculosis and fungal infections present similar symptoms, especially in immunocompromised individuals. Differentiating these diseases requires specific tests like Aspergillus-specific IgG serology and CT imaging for accurate diagnosis.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Pulmonology

Background:

  • Tuberculosis (TB) and systemic fungal diseases are opportunistic infections.
  • Immunocompromised individuals, particularly people living with human immunodeficiency virus (PLHIV), often present with overlapping symptoms.
  • Chronic pulmonary aspergillosis (CPA) shares clinical characteristics with pulmonary tuberculosis (PTB), posing a significant diagnostic challenge.

Purpose of the Study:

  • To review the prevalence, clinical manifestations, and diagnostic challenges of TB and fungal infections.
  • To highlight the importance of accurate differentiation between PTB and CPA.
  • To discuss diagnostic tools for various fungal infections mimicking TB.

Main Methods:

  • Literature review analyzing prevalence, clinical presentation, and diagnostic strategies.
  • Comparison of diagnostic methods including serology, GeneXpert, and CT imaging.
  • Discussion of cytokine profiles (Th2, IFN-γ) in CPA patients.

Main Results:

  • CPA diagnosis is often considered after ruling out PTB, but the reverse is less common.
  • Fibrosis and cavitation in CPA can lead to misdiagnosis.
  • Aspergillus-specific IgG serology is vital for distinguishing PTB/relapse from CPA.
  • Other fungal infections (mucormycosis, cryptococcosis, histoplasmosis, blastomycosis) also mimic TB symptoms.
  • Radiographic analysis is insufficient for definitive diagnosis.
  • GeneXpert rapidly detects TB and drug resistance; CT imaging is superior for CPA and other fungal infections.

Conclusions:

  • Accurate differentiation between TB and fungal infections is critical, especially in immunocompromised patients.
  • Specific diagnostic tools are necessary to avoid misdiagnosis and ensure appropriate treatment.
  • CT imaging and Aspergillus-specific IgG serology play key roles in diagnosing CPA and differentiating it from PTB.
Keywords:
AspergillosisFungal InfectionMucormycosisMycobacteriaTuberculosis

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