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Review 2: "Chronic Pulmonary Aspergillosis Incidence in Newly Detected Pulmonary Tuberculosis Cases during Follow-up"

Reviewers were mixed, with some finding the study well-written and important while others had concerns about generalizability, misclassification of CPA/TB, and interpretability of findings.

Published onApr 09, 2024
Review 2: "Chronic Pulmonary Aspergillosis Incidence in Newly Detected Pulmonary Tuberculosis Cases during Follow-up"
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key-enterThis Pub is a Review of
Chronic pulmonary aspergillosis incidence in newly detected pulmonary tuberculosis cases during follow-up
Chronic pulmonary aspergillosis incidence in newly detected pulmonary tuberculosis cases during follow-up
Description

Abstract Background Chronic pulmonary aspergillosis (CPA) is known to complicate patients with post-tubercular lung disease. However, some evidence suggests that CPA might co-exist in patients with newly-diagnosed pulmonary tuberculosis (P.TB) at diagnosis and also develop during therapy. The objective of this study was to confirm the presence of CPA in newly diagnosed P.TB at baseline and at end-of-therapy.Materials & Methods This prospective longitudinal study included newly diagnosed P.TB patients, followed up at third month and end-of-therapy with symptom assessment, anti-Aspergillus IgG antibody and imaging of chest for diagnosing CPA.Results We recruited 255 patients at baseline out of which 158 (62%) completed their follow-up. Anti-Aspergillus IgG was positive in 11.1% at baseline and 27.8% at end-of-therapy. Overall, proven CPA was diagnosed in 7% at baseline and 14.5% at end-of-therapy. Around 6% patients had evidence of aspergilloma in CT chest at the end-of-therapy.Conclusions CPA can be present in newly diagnosed P.TB patients at diagnosis and also develop during anti-tubercular treatment. Patients with persistent symptoms or developing new symptoms during treatment for P.TB should be evaluated for CPA.

RR:C19 Evidence Scale rating by reviewer:

  • Strong. The main study claims are very well-justified by the data and analytic methods used. There is little room for doubt that the study produced has very similar results and conclusions as compared with the hypothetical ideal study. The study’s main claims should be considered conclusive and actionable without reservation.

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Review: The authors’ object is to study chronic pulmonary aspergillosis (CPA) in the pulmonary TB population through a longitudinal study. CPA was proven by clinical examination, radiology and mycological laboratory investigation both conventional & non-culture methods (IgG and Galactomannan).

While this study has been conducted and the results are well written, I would like to comment on the aim of the study: "The present study was designed to estimate the burden of anti-Aspergillus IgG positivity and CPA in newly-diagnosed P.TB patients both at baseline and end-of-therapy with the aim of avoiding the limitations mentioned above." Wouldn't it be better if the aim of the study was to find out the burden of CPA and the dynamics of IgG existence among the newly diagnosed PTB? The results of this study prove that there is a dynamic immune response shown by the conversion of IgG to negative after TB treatment. Secondly, what is the purpose of the Galactomannan test? Is it to find out the possibility of invasion by Aspergillus? This should be discussed in the Discussion section.

In my opinion, this manuscript is important as a basis for further research, especially in the field of epidemiology and also for policy makers. Why? because there are so many cases of pulmonary TB, especially in developing countries, and not all countries have conducted research to map the conditions in their respective countries. Researchers are indeed independent, but when it comes to surveys to map diseases such as CPA, the intervention of policy makers will be very meaningful. Meanwhile, lay people can wait until there is more complete data, e.g. covering a larger number of subjects.

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