Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Directorate of Programs, Mildmay Uganda, Wakiso.
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara.
Int J Tuberc Lung Dis. 2021 Jul 1;25(7):537-546. doi: 10.5588/ijtld.21.0034.
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. 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. 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 paracavitary fibrosis are more common in CPA. -specific IgG serology has a central role in differentiating PTB (both active and healed) from CPA with a high sensitivity and specificity. -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.
肺结核（PTB）和慢性肺曲霉病（CPA）都是进行性和使人虚弱的实质性肺病，具有重叠的风险因素、症状和影像学表现，这常常导致这两种疾病中的任何一种被误诊。我们采用叙述性综述的方法来描述 CPA 和 PTB 的临床和影像学表现，并强调区分这两种密切相关疾病的显著特征。CPA 是治疗后 PTB 的常见并发症。事实上，在 PTB 治疗后遗留肺部病变的患者中，有 15-90%的患者会发生 CPA。虽然 CPA 主要影响有基础肺部疾病的老年患者，但 PTB 和 CPA 的临床表现均无明显差异。空洞和纤维化的胸部影像学表现对这两种疾病均常见。然而，淋巴结病、粟粒样模式和胸腔积液提示活动性 PTB，而曲霉肿、胸膜增厚和旁空洞纤维化更常见于 CPA。抗真菌 IgG 血清学在区分 PTB（包括活动性和已愈合的）和 CPA 方面具有重要作用，具有较高的敏感性和特异性。抗真菌 IgG 血清学是区分 PTB 和 PTB 复发与 CPA 的关键。在低收入环境中开发可用于区分活动性结核病、PTB 后疾病和 TB+CPA 合并感染的临床预测评分可能是有价值的。
