Prevalence of Chronic Pulmonary Aspergillosis Along the Continuum of Pulmonary Tuberculosis Care: a Protocol for a Living Systematic Review and Meta-analysis

Felix Bongomin, Ronald Olum, Winnie Kibone, Martha Namusobya, Norman van Rhijn, David W. Denning


Chronic pulmonary aspergillosis (CPA) is a debilitating disease estimated to affect over 3 million people worldwide. Pulmonary tuberculosis (PTB) is the most significant risk factor for CPA. However, the true burden of CPA at the time of PTB diagnosis, during, and after PTB treatment remains unknown. In this paper, we present a protocol for a living systematic review aimed at estimating the current burden of CPA along the continuum of PTB care.


Chronic pulmonary aspergillosis (CPA) is a slowly progressive and destructive parenchymal lung disease mostly caused by Aspergillus fumigatus and affecting both immunocompetent and subtly immunocompromised patients, particularly those with previous or underlying structural lung damage due to infectious and non-infectious diseases such as pulmonary tuberculosis (PTB), fibrocystic sarcoidosis, non-tuberculous Mycobacterium–pulmonary disease, and others [12]. Of these, active, or previous treated PTB is the most common with prevalence ranging between 15% and 90% of patients with CPA [34].

Materials and method

This systematic review and meta-analysis will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [20], including the PRISMA-Protocol (PRISAM-P) checklist. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023453900).


This will be the first comprehensive review to estimate the burden of CPA along the continuum of PTB care. It is now widely accepted that CPA may be confused with, or a co-infection of PTB, or may manifest itself as a complication following anti-TB therapy [17]. However, very few prospective cohort studies have been conducted to explore evolution (such as progression and or spontaneous resolution of CPA) and emergence of new CPA cases during and after PTB therapy [5, 10, 25, 26]. Furthermore, due to lack of evidence, there is no consensus on the timing of when PTB associated CPA should be screened.


In summary, this intended living systematic review aims to consolidate the existing evidence concerning the burden of CPA at various stages of PTB care: at the time of PTB diagnosis, during PTB treatment, and post-PTB treatment and will be updated regularly to inform research and practice. The outcomes of this study hold the promise of informing healthcare policies regarding CPA screening, improving clinical decision-making, and stimulating additional research to unravel the complex relationship between PTB and CPA. By illuminating the prevailing burden of CPA throughout the spectrum of PTB care, our goal is to make a meaningful contribution to the enhancement of patient care, disease management, and global health outcomes.

Citation: Bongomin F, Olum R, Kibone W, Namusobya M, van Rhijn N, Denning DW (2023) Prevalence of chronic pulmonary aspergillosis along the continuum of pulmonary tuberculosis care: A protocol for a living systematic review and meta-analysis. PLoS ONE 18(12): e0294634.

Editor: Aleksandra Barac, Clinic for Infectious and tropical diseases, Clinical centre of Serbia, SERBIA

Received: September 19, 2023; Accepted: November 5, 2023; Published: December 15, 2023

Copyright: © 2023 Bongomin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: No datasets were generated or analysed during the current study. All relevant deidentified research data from this study will be made available upon study completion and publication.

Funding: This work was financially supported by the Carigest SA Conny Naeva Charitable Foundation as part of PhD studentship award to Dr Felix Bongomin at the University of Manchester, United Kingdom. No additional external funding was received for this study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.






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