Pulmonary TB and chronic pulmonary aspergillosis: clinical differences and similarities
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Date
2021-02-23
Journal Title
Journal ISSN
Volume Title
Publisher
International Union Against Tuberculosis and Lung Disease
Abstract
BACKGROUND: Pulmonary TB (PTB) and chronic
pulmonary aspergillosis (CPA) are both progressive and
debilitating parenchymal lung diseases with overlapping
risk factors, symptomatology and radiological findings
that often result in misdiagnosis of either disease.
METHODS: We undertook a narrative review approach
to describe the clinical and radiological manifestations
of CPA and PTB and highlight the salient features that
differentiate these two closely related maladies.
RESULTS: CPA is a frequent complication of treated
PTB. In fact, 15–90% of CPA cases occur in patients
with residual lung lesions following treatment for PTB.
While CPA predominantly affects older patients with
underlying lung diseases, both PTB and CPA present
with clinically indistinguishable symptoms. Chest imaging findings of cavitation and fibrosis are common to
both diseases. However, lymphadenopathy, miliary
pattern and pleural effusion are predictive of active
PTB, while aspergilloma, pleural thickening and para cavitary fibrosis are more common in CPA. Aspergillus specific IgG serology has a central role in differentiating
PTB (both active and healed) from CPA with a high
sensitivity and specificity.
CONCLUSION: Aspergillus-specific IgG serology is key
in differentiating PTB and PTB relapse from CPA. It
may be worthwhile developing clinical predictive scores
that can be used in low-income settings to differentiate
active TB, post-TB disease and TB+CPA co-infection
Description
Keywords
tuberculosis;, clinical features;, CPA;, differential diagnosis;, differences
Citation
Baluku, J. B., Nuwagira, E., Bongomin, F., & Denning, D. W. (2021). Pulmonary TB and chronic pulmonary aspergillosis: Clinical differences and similarities. The International Journal of Tuberculosis and Lung Disease, 25(7), 537-546.