Clinical features, diagnostic test performance, treatment and outcome of pulmonary tuberculosis patients with chronic pulmonary aspergillosis in China: a retrospective, observational study

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.