Clinical and diagnostic misperception of tuberculosis and systemic fungal infections

• Aspergillus flavus is the primary cause of CPA. Fibrosis and cavitation on CPA chest imaging may resemble PTB lesions. • Delayed detection of TB and histoplasmosis and limited access to anti-fungal medications contribute to poor clinical outcomes. • Innate and adaptive immune cells like dendritic cells and macrophages respond to intracellular infections cryptococcus and TB. Tuberculosis and systemic fungal diseases are opportunistic and challenging to diagnose. However, in immunocompromised people, especially people living with human immunodeficiency virus (PLHIV), the signs and symptoms of both diseases highly imitate each other. Primarily, chronic pulmonary aspergillosis (CPA) could have similar clinical characteristics to tuberculosis in lungs, and it is a major diagnostic challenge. Thus, the aim of the review is to analyze the prevalence, clinical manifestation, and challenges associated with the diagnostic consequences of TB and fungal infections. Although pulmonary tuberculosis (PTB) is routinely ruled out before a chronic pulmonary aspergillosis diagnosis and is widely accepted as an alternate diagnosis of CPA, the contrary is infrequent. Patients with chronic pulmonary aspergillosis usually exhibit a Th2 cytokine profile and may produce little or no IFN-γ. When fibrosis and cavitation appear on chest imaging in CPA, these patients may be misdiagnosed and neglected, which could have detrimental effects. Aspergillus-specific IgG serology is crucial for differentiating PTB and PTB relapse from CPA. Likewise, other fungal infections such as mucormycosis, cryptococcosis, histoplasmosis, and blastomycosis also reveal similar clinical manifestations to tuberculosis. Thereby, radiographic analysis is a typical diagnostic method; however, it cannot reliably detect illness symptoms. Consequently. GeneXpert can detect TB and resistance of RIF/INH in the short period, while CT imaging is better for chronic pulmonary aspergillosis and other fungal infections.