Allergic Bronchopulmonary Aspergillosis

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Contents 1 Introduction 2 Etiology 3 Pathology 4 Clinical-manifestations 5 Diagnostic-criteria 6 Laboratory 7 Radiology 8 Management 9 More General Terms 10 Internet Database 11 References

Introduction

• Obstructive lung disease caused by an allergic reaction to Aspergillus in the lower airway. It frequently develops in patients with asthma, COPD or cystic fibrosis.

Etiology

• Aspergillus fumigatus (most common)
• Candida albicans
• Aspergillus terreus
• Curvularia lunata
• Helminthosporium species
• Stemphyllium lanuginosum

Pathology

• pulmonary fibrosis

Clinical-manifestations

• persistent, severe, steroid-dependent asthma
• proximal, segmental bronchiectasis
• fever
• expectoration of mucoid plugs, brown sputum
• may be overlooked until onset of more advanced disease

Diagnostic-criteria

• Major criteria:

• asthma
• blood eosinophilia (> 1000/ mm3)
• immediate skin reactivity (Type-I, IgE-mediated) to Aspergillus antigen
• IgG antibodies (Type-III) to Aspergillus antigen
• high serum IgE (> 1000 ng/mL)
• transient or fixed pulmonary infiltrates
• central ( proximal) bronchiectasis
  

• Minor criteria:

• presence of Aspergillus in sputum
• expectoration of brownish mucus plugs
• late phase ( Arthus, type IV) skin-reactivity to Aspergillus antigen

Laboratory

• increased serum IgE

• normal level virtually excludes diagnosis of allergic bronchopulmonary aspergillosis
• serum IgE can be used to assess the therapeutic response to prednisone

• antibodies to Aspergillus

• skin test for IgE to Aspergillus
• serum IgG & serum IgE specific for Aspergillosis

• complete blood count ( CBC): eosinophilia
• sputum examination: (expectorated mucoid plugs)

• eosinophils
• Aspergillus mycelia Pulmonary function tests:

• consistent with obstructive lung disease not responsive to bronchodilator

Radiology

• pulmonary infiltrates

• especially in upper lobes
• may be transient or fixed

• atelectasis
• central bronchiectasis
• 'gloved finger sign'
• 'tramtrack line'
• 'toothpaste shadows'

Management

• systemic glucocorticoids (> 6 months duration)
• antifungal therapy not useful
• serum IgE may useful for following course of disease

More General Terms

• aspergillosis
• type 1 hypersensitivity; immediate hypersensitivity (allergy)
• lung disease

Internet Database

OMIM: 103920

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 18, 20, 754
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009

allergic bronchopulmonary aspergillosis (ABPA)