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

BACKGROUND

Tuberculosis (TB) is a major global health concern, with long-term complications persisting even after successful treatment. Chronic pulmonary aspergillosis (CPA) is a progressive fungal disease that frequently develops in TB survivors, contributing to post-TB lung disease. The true burden of CPA among patients with TB remains unclear due to diagnostic challenges and limited data. We aimed to estimate the prevalence of CPA among patients with prior or concurrent TB.

METHODS

We conducted a systematic search in PubMed, Cochrane Library, Web of Science, and Science Direct through 10 January 2025. Eligible cohort and cross-sectional studies reported CPA prevalence in patients diagnosed with TB based on clinical symptoms, radiographic abnormalities, and microbiological evidence. Three reviewers screened 1575 unique studies, assessed 118 full texts, and included 22 studies (2884 patients). We conducted a meta-analysis using a random-effects model to estimate pooled CPA prevalence, with subgroup and meta-regression analyses exploring factors influencing CPA burden.

RESULTS

CPA prevalence varied by timing of assessment and symptom status. Among all patients with TB, CPA prevalence was 9% (95% confidence interval [CI]: 6%-12%) during treatment and 13% (95% CI: 6%-27%) posttreatment. Among patients with persistent respiratory symptoms, CPA prevalence was 20% during treatment and 48% (95% CI: 36%-61%) posttreatment. Meta-regression identified symptom status and timing of CPA assessment as significant predictors of CPA prevalence.

CONCLUSIONS

The high CPA burden among TB survivors, particularly those with persistent symptoms, underscores the need for routine CPA screening in TB programs. Early detection and targeted interventions could reduce respiratory complications and improve patient outcomes.