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

Summary

This article addresses confusion between two Aspergillus lung infections that commonly occur after tuberculosis: ABPA and CPA. While they have overlapping symptoms and test results, they require different treatments—ABPA responds to short-term steroids while CPA needs prolonged antifungal drugs. Importantly, giving steroids for misdiagnosed CPA can be harmful, so doctors should be cautious about diagnosing ABPA in tuberculosis survivors and consider CPA instead.

Background

Aspergillus species can cause various pulmonary diseases depending on immune status, ranging from invasive aspergillosis to allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). ABPA and CPA are often misdiagnosed or mislabeled due to overlapping clinical, radiological, and immunological features. Recent studies report ABPA in post-tuberculosis lung abnormalities, raising questions about whether this represents genuine ABPA or misclassified CPA.

Objective

This editorial explores the association between ABPA and pulmonary tuberculosis, examines how ABPA and CPA can coexist or complicate prior tuberculosis, and underscores the importance of accurately distinguishing between these conditions. The authors aim to address diagnostic confusion and prevent both underrecognition and overdiagnosis of ABPA in post-tuberculosis populations.

Results

The paper identifies significant diagnostic overlap between ABPA and CPA, with nearly one-fifth of CPA patients fulfilling conventional ABPA diagnostic criteria. Studies show 2.27% of post-tuberculosis lung abnormality patients meet ABPA criteria, though these likely represent CPA misclassification. Coexistence of ABPA with active tuberculosis is rare but documented in case reports.

Conclusion

In patients with fibrocavitary tuberculosis sequelae, ABPA diagnosis should be made cautiously despite presence of classical ABPA features and positive immunological markers. CPA should be suspected in such cases rather than ABPA, as inappropriate glucocorticoid therapy for misclassified CPA may worsen disease and increase invasive aspergillosis risk. Future advances in diagnostic tools differentiating Th1 and Th2 immune responses are needed.
  • Published in:Lung India,
  • Study Type:Editorial Review,
  • Source: PMID: 41129569, DOI: 10.4103/lungindia.lungindia_412_25
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