A Systematic Review of Chronic Pulmonary Aspergillosis Among Patients Treated for Pulmonary Tuberculosis.

Summary

Across 22 studies (n=2884), pooled CPA prevalence among TB patients was 9% during treatment and 13% post-treatment; in those with persistent respiratory symptoms, prevalence reached 20% and 48%, respectively. Symptom status and timing of assessment were key predictors, supporting routine CPA screening within TB programs.

Key Findings

• Pooled CPA prevalence among TB patients: 9% during treatment and 13% post-treatment.
• Among TB patients with persistent respiratory symptoms, CPA prevalence was 20% during treatment and 48% post-treatment.
• Meta-regression identified symptom status and timing of CPA assessment as significant predictors of prevalence.

Clinical Implications

Implement CPA screening (serology, imaging, mycology) during and after TB treatment, especially in patients with persistent respiratory symptoms, to initiate antifungal therapy and reduce long-term respiratory impairment.

Limitations

• Diagnostic heterogeneity of CPA across studies may influence pooled estimates.
• Geographical and healthcare setting variability may limit generalizability.

Future Directions

Standardize CPA diagnostic algorithms within TB programs and evaluate cost-effectiveness of routine screening; conduct prospective cohorts to define outcomes with early antifungal treatment.