A NEW systematic review highlights a significant but often overlooked complication in tuberculosis (TB) survivors—chronic pulmonary aspergillosis (CPA), a progressive fungal disease that can severely impact respiratory health. The study reveals that CPA affects up to 48% of TB survivors with ongoing respiratory symptoms, emphasizing the urgent need for better screening and early intervention.
TB remains a global health crisis, but even after successful treatment, many patients face long-term lung complications. CPA, caused by the Aspergillus fungus, develops in damaged lung tissue, leading to severe breathing difficulties, weight loss, and chronic fatigue. However, due to diagnostic challenges, many cases go undetected, leaving patients at risk for worsening respiratory failure.
The systematic review analyzed data from 22 studies, encompassing 2,884 patients with TB. Researchers found that CPA prevalence during TB treatment was 9%, rising to 13% post-TB treatment. Among patients with TB with persistent respiratory symptoms, CPA prevalence was significantly higher, reaching 48% after treatment. These findings suggest that nearly half of TB survivors with ongoing symptoms could have CPA, highlighting the urgent need for improved post-TB care.
The study underscores the necessity of routine CPA screening, particularly in TB survivors with lingering respiratory issues. Early detection through clinical evaluation, radiographic imaging, and microbiological testing can lead to timely antifungal treatment, potentially preventing severe lung damage. With CPA often misdiagnosed as TB relapse or other lung diseases, healthcare providers should maintain a high index of suspicion in post-TB patients. Integrating CPA screening into TB programs could significantly improve patient outcomes and reduce the burden of post-TB lung disease.
For clinicians treating patients TB, this study serves as a crucial reminder that TB recovery doesn’t always mean an end to respiratory complications. Proactive screening for CPA can make a life-saving difference.
Reference: Madden A et al. A systematic review of chronic pulmonary aspergillosis among patients treated for pulmonary tuberculosis. Clin Infect Dis. 2025;ciaf150.
Anaya Malik | AMJ
