Fact-sheet: Allergic bronchopulmonary aspergillosis
Updated on 10/07/2017 at 8:04 AM
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Definition
- IMMUNOLOGIC/ALLERGIC disease = immediate and semi-delayed hypersensitivity to Aspergillus fumigatus.
- Involved in 13% of asthmatic disease, 10% in patients with cystic fibrosis.
- Association of asthma, recurrent pulmonary infiltrates, and bronchiectasis.
- Occurs in adults between 30 and 40 years of age.
Clinical features
Presents with low-grade fever, asthma, hemoptysis, and productive cough.
Asthma is generally poorly controlled.
Laboratory findings
- positive skin reaction to Aspergillus,
- serum hypereosinophilia,
- positive serum precipitins to Aspergillus,
- positive specific IgE and IgG
- Aspergillus filaments in bronchial secretions
Radiography
- Bilateral, proximal bronchial syndrome
- Bilateral alveolar opacities, poorly demarcated, hazy
CT
- Central, proximal, upper lobe bronchiectasis: "filled" before treatment, "empty" after treatment, inverted "Y" appearance
- Best ventilated zones
- Mucoid impactions,
- Hazy centrilobular micronodules with "tree-in-bud" appearance,
- Bronchial wall thickening
More rarely and later:
- Areas of atelectasis
- Pseudocystic changes
- Pleural involvement
Management
- fungal eradication
- corticosteroids (inhaled or systemic)
Classification
Rosenberg-Patterson diagnostic criteria:
- Major: asthma, radiographic infiltrates, positive skin reaction to Aspergillus, serum hypereosinophilia, positive serum precipitins to Aspergillus, proximal bronchiectasis, positive specific IgE and IgG
- Minor: Aspergillus filaments in bronchial secretions, brownish mucus plugs in sputum, delayed skin reaction to Aspergillus
=> Positive diagnosis if 6 major criteria are present
