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ABPA in post-tuberculosis lung disease: A diagnostic pitfall or genuine entity?

Summary

After tuberculosis treatment, some patients develop fungal lung infections that can look very similar to an allergic fungal disease called ABPA. This editorial warns doctors that they need to be careful about diagnosing ABPA in tuberculosis patients because treating it with the wrong medications could make the fungal infection worse. The key difference is that true ABPA causes wheezing and asthma-like symptoms, while post-TB fungal infections cause cavities and scarring in the lungs.

Background

Aspergillus species can cause various pulmonary diseases depending on immune status, ranging from invasive aspergillosis in immunocompromised individuals to allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA) in immunocompetent hosts. ABPA and CPA are frequently misdiagnosed or mislabeled due to overlapping clinical features, immunological markers, and lack of reference standard tests.

Objective

This editorial explores the association between ABPA and pulmonary tuberculosis, examines how ABPA and CPA can coexist or complicate prior pulmonary tuberculosis, and underscores the critical importance of accurately distinguishing between these conditions to avoid both underrecognition and overdiagnosis.

Results

Recent studies show 2.27% of patients with post-tuberculosis lung abnormalities meet ABPA diagnostic criteria, though this likely reflects diagnostic overlap rather than true ABPA prevalence. Approximately 37% of ABPA patients reported prior anti-tuberculosis exposure. Nearly one-fifth of CPA patients fulfill conventional ABPA diagnostic criteria, demonstrating significant immunological overlap.

Conclusion

In patients with fibrocavitary sequelae of tuberculosis, ABPA diagnosis should be made cautiously even with classical features present. CPA diagnosis threshold should be low in this context, and misclassifying CPA as ABPA and treating with systemic glucocorticoids may worsen disease progression and increase invasive aspergillosis risk.
  • Published in:Lung India,
  • Study Type:Editorial Review,
  • Source: PMID: 41129569, DOI: 10.4103/lungindia.lungindia_412_25
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