PERSIST: Post tuberculosis lung disease and fungal infections in Indonesia: clinical characteristics and underlying mechanisms

Following completion of tuberculosis (TB) treatment, numerous patients experience post-TB lung disease (PTLD), characterized by chronic airway obstruction or respiratory infections. The precise pathogenesis of PTLD is largely unknown. An imbalance between TB-induced inflammation and tissue repair likely contributes to abnormal lung tissue remodeling. Lung damage (e.g cavity formation) creates a niche for growth of saprophytic fungi, such as Aspergillus sp., but TB-induced epigenetic and immune dysregulation may also be important. In this prospective cohort study conducted in Indonesia, the country with the second highest TB burden and suboptimal cure rates, I aim to investigate the clinical-radiological features and causes of PTLD. Many of these patients may actually suffer from PTLD, including chronic fungal infections. As a secondary objective I want to study the prevalence and treatment outcomes of post-TB fungal disease (aspergillosis and histoplasmosis). Lastly, the project aims to identify biological pathways involved in PTLD, through a combination of immunological and epigenetic analyses of patient samples. This research will contribute significantly to the understanding and management of PTLD in Indonesia, addressing a pressing health concern and expanding the knowledge base in this emerging field.