Association between allergic bronchopulmonary aspergillosis or Aspergillus sensitization and tuberculosis: A systematic review of 607 cases

Abstract

Introduction

Although allergic bronchopulmonary aspergillosis (ABPA) is classically described in asthma and cystic fibrosis, pulmonary tuberculosis (PTB) with post-tubercular lung disease (PTLD) has been reported as a likely predisposing factor. It, however, has not been reviewed systematically, which we aimed to achieve in the current systematic review.

Methods

We screened the available literature from PubMed, Embase, SCOPUS and Web of Science databases for studies reporting association between ABPA and PTB from the beginning of time to June 30, 2023 and collated the data on association of ABPA and tuberculosis.

Results

1176 articles were identified from the initial search, of which 60 articles (27 original articles and 33 case reports) were included in the final analysis. Four patterns were described: ABPA in patients with previous TB (151, 24.9 %), co-existent ABPA and TB (16, 2.6 %), Aspergillus sensitization in patients with prior or current TB (91, ∼15 %) and ABPA misdiagnosed as TB (349, 57.5 %). There was significant heterogeneity in the diagnostic criteria used for ABPA and pulmonary TB. From limited individual data, which could be extracted, observations were: 1) Central bronchiectasis (32.6 %), cavity (22.8 %), fungal ball (12.0 %), mucus plug/high attenuation mucus (HAM) (7.6 %) and consolidation/centrilobular nodules (12.0 %) were the most common radiographic abnormalities. 2) 96.4 % received steroids, 11 % received antifungals mostly for relapse or inadequate response. 3) Adequate treatment response was noted in the limited cohort where it was reported.

Conclusions

ABPA is commonly misdiagnosed as TB, but Aspergillus sensitization/ABPA can develop in patients with prior TB. However, significant heterogeneity in diagnostic criteria limits generalizability. Future well-designed prospective studies are required to confirm these associations.