Observational studyFrontiers in cellular and infection microbiology2025
Clinical features, diagnostic test performance, treatment and outcome of pulmonary tuberculosis patients with chronic pulmonary aspergillosis in China: a retrospective, observational study.
Observational study in Frontiers in cellular and infection microbiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Chronic pulmonary aspergillosis (CPA) is a major sequela of pulmonary tuberculosis (PTB), posing a significant health burden in high-prevalence regions like China. However, data on the clinical spectrum, diagnostic challenges, and outcomes of PTB-associated CPA in the Chinese population remain limited. Methods: This retrospective single-center study analyzed 220 patients with PTB-associated CPA in Wuhan Pulmonary Hospital (January-December 2022). CPA was diagnosed and subtyped according to European guidelines: simple aspergilloma (SA, n=31), chronic cavitary pulmonary aspergillosis (CCPA, n=120), chronic fibrosing pulmonary aspergillosis (CFPA, n=39), Aspergillus nodule (AN, n=25), and semi-invasive pulmonary aspergillosis (SAIA, n=5). Data pertaining to demographic and clinical characteristics, comorbidities, imaging findings, diagnostic test performance, antifungal treatment regimens, and clinical outcomes were retrospectively analyzed. Results: The cohort had a median age of 56.7 years, with a 64.1% male predominance. Cough (94.1%) and sputum (83.2%) were the most common symptoms, while hemoptysis was highest in CFPA (79.5%). Chest CT revealed cavities in 87.7% and a high prevalence of fibrosis in CFPA (89.7%). Serologically, serum Aspergillus IgG was positive in 68.2% of patients, with the highest positivity in CFPA (74.4%). BALF galactomannan positivity was highest in AN (76.0%). Voriconazole was the primary antifungal agent (69.1%), but 70.5% of patients received therapy for ≤6 months. Outcomes varied by subtype. CFPA had the worst prognosis (38.5% disease progression, 10.3% mortality), whereas AN patients demonstrated the highest clinical stability (92.0% stable disease). Conclusion: PTB-associated CPA in China exhibits distinct subtype characteristics. Accurate diagnosis requires a combination of modalities. Treatment responses vary by subtype, underscoring the need for region-specific clinical guidelines, multidisciplinary management, and further research on treatment duration, multi-center cohort studies, and improved diagnostic approaches.
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