Identification of Misdiagnosis Factors in Allergic Bronchopulmonary Mycosis Using Explainable Machine Learning
Xuemei Chen1,2, Zekai Yu3, Xiaoxiao Gong1,2
1Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
Journal of Asthma and Allergy
|May 15, 2026
Summary
Allergic bronchopulmonary aspergillosis (ABPA) is often misdiagnosed as tuberculosis due to similar symptoms. Immunological markers, not imaging, are key to accurate ABPA diagnosis, preventing treatment delays.
Area of Science:
- Pulmonology
- Infectious Disease Epidemiology
- Medical Diagnostics
Background:
- Allergic bronchopulmonary aspergillosis/mycosis (ABPA/ABPM) shares clinical and radiological similarities with pulmonary tuberculosis, leading to frequent misdiagnosis.
- This diagnostic challenge is particularly pertinent in tuberculosis-endemic regions.
Purpose of the Study:
- To investigate the determinants of misdiagnosis in ABPA/ABPM patients.
- To identify causal drivers of misdiagnosis, distinguishing them from spurious associations.
Main Methods:
- Retrospective cohort study of 89 multidisciplinary team (MDT)-confirmed ABPA/ABPM patients.
- Application of machine learning models with SHAP interpretation and a Double Machine Learning framework.
- Estimation of average treatment effects for five key features, adjusting for major confounders.
Main Results:
- Immunological markers were identified as the primary contributors to misdiagnosis.
- Total serum IgE and Aspergillus fumigatus-specific IgE demonstrated significant protective causal effects against misdiagnosis.
- Bronchiectasis showed a modest protective effect, with findings robust across multiple analytical checks.
Conclusions:
- Misdiagnosis of ABPA/ABPM is predominantly driven by the underrecognition of immunological features, rather than imaging findings.
- Systematic immunologic assessment is crucial to reduce diagnostic delays and avoid unnecessary anti-tuberculosis treatment.
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