Allergic bronchopulmonary aspergillosis due to Aspergillus oryzae

A 19-year-old female student with allergic bronchopulmonary aspergillosis (ABPA) due to Aspergillus oryzae is reported. This organism was used for fermentation starter to make soybean paste in her father's workshop adjacent to the home where she lived. ABPA might be considered an occupational disease in certain situations.     

Allergic bronchopulmonary aspergillosis.

A case of allergic bronchopulmonary aspergillosis (ABPA) is presented, followed by a discussion of the clinical characteristics, pathogenesis, diagnosis, and management of this disease. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. ABPA is a hypersensitivity response to Aspergillus antigens in the lung and is distinct from other forms of Aspergillus pulmonary disease. Episodic bronchospasm, expectoration of mucous plugs, and fleeting pulmonary infiltrates are common manifestations of the disease. Several diagnostic schemes for ABPA have been described with varying criteria, which uniformly includes asthma and positive immediate skin-prick test to Aspergillus fumigatus. The mainstay of treatment for ABPA is corticosteroids, which are normally effective.     

Allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is not a common condition, even though asthma due to sensitization to Aspergillus antigen is very common in many countries because of the ubiquitous distribution of the fungus itself. During the course of 14 years, the Mycology Department of the V. P. Chest Institute, Delhi, has confirmed the diagnosis of ABPA in 46 patients. The present study is based on the follow-up of 17 patients for understanding the evolution of the disease. All of them had Aspergillus fumigatus (AF) in the sputum with positive type I and type III skin reaction to AF antigen. 7 patients were treated for 10 days with oral administration of Hamycin, an antibiotic isolated from one of the streptomycete species. Immediate results were very good, with marked alleviation of subjective symptoms and absence of fungi in the sputum. The drug deserves further trial.     

Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is caused by an exaggerated T(H)2 response to the ubiquitous mold Aspergillus fumigatus. ABPA develops in a small fraction of patients with cystic fibrosis and asthma, suggesting that intrinsic host defects play a major role in disease susceptibility. This article reviews current understanding of the immunopathology, clinical and laboratory findings, and diagnosis and management of ABPA. It highlights clinical and laboratory clues to differentiate ABPA from cystic fibrosis and asthma, which are challenging given clinical and serologic similarities. A practical diagnostic algorithm and management scheme to aid in the treatment of these patients is outlined.     

Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis is an uncommon but serious respiratory condition characterized by chronic airway inflammation and airway damage resulting from persistent colonization by and sensitization to the fungus Aspergillus fumigatus. The immunopathogenesis of allergic bronchopulmonary aspergillosis involves several pathways. Aspergillus allergens stimulate an interleukin 5-mediated Th2 pathway responsible for the eosinophilic infiltrate, whereas aspergillus proteases promote epithelial activation and a potent chemokine response that induces neutrophilic airway inflammation. The resulting airway inflammation is intense, involves tissue damage and remodeling, and is linked with the severity of bronchiectasis. Treatment involves corticosteroids and antifungal therapy with oral azoles. Additional management seeks to monitor and control the other disease components of severe asthma, bronchiectasis, and disease exacerbations.     

Allergic bronchopulmonary aspergillosis caused by Aspergillus terreus presenting lobar collapse.

A case of allergic bronchopulmonary aspergillosis (ABPA) is described which presents left upper lobe collapse caused by Aspergillus terreus, an organism rarely found in ABPA. It is unusual for initial radiographic findings of ABPA to include extensive collapse.     

Allergic bronchopulmonary aspergillosis masquerading as invasive pulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a noninvasive complex hypersensitivity reaction that occurs in immunocompetent patients with asthma. Aspergillus can invade and disseminate, but this more commonly occurs in severely immunocompromised patients receiving high-dose corticosteroids. We report the case of a 13-year-old immunocompetent male patient with moderate persistent asthma who appeared to have invasive pulmonary aspergillosis on radiographic studies. With further evaluation and workup, it was determined that the patient did not have invasive pulmonary aspergillosis, but that he met the diagnostic criteria for ABPA. Although initially there was a deceptive invasive appearance, proper identification of ABPA facilitated selection of corticosteroid treatment that resulted in prompt clearing of the concerning infiltrates.     

Allergic bronchopulmonary aspergillosis and fungoses

ABPA is more common than was once suspected, while it remains likely that ABPF is rare. The spectrum of ABPA ranges from mild asthma to end-stage fibrotic lung disease. The episodes of chest roentgenographic infiltrates may be associated with little symptomatology and their detection is made by serial measurement of total serum IgE. A useful serodiagnostic aid for identification of early cases of ABPA is the demonstration of elevated IgE and IgG antibodies to Af compared with patients with asthma who do not have ABPA. Such assays are helpful in childhood cases of ABPA and in cystic fibrosis where no other test is as sensitive and specific. Prednisone remains the treatment of choice and, in many cases, its use can be intermittent.     

Allergic bronchopulmonary aspergillosis disclosing mucoviscidosis

In predisposed patients, allergic bronchopulmonary aspergillosis (ABPA) can arise from aspergillus bronchial colonization. We report the case of a young woman who presented with a right basal pneumonia, ground glass opacities and mediastinal adenopathies on CT scan. Biological, radiological and clinical criteria, as well as an history of childhood asthma, allowed the initial diagnosis of ABPA. However, the unusual coexistence of an additional infection with Pseudomonas Aeruginosa evoked the diagnosis of cystic fibrosis, confirmed by a sweat test and genetic analysis. Under corticosteroid and antifungal therapy and antibiotics, the clinical and radiological evolution was favourable but immuno-allergic sensitisation persisted. The ABPA-cystic fibrosis association is not rare with an estimated prevalence of 2% to 11% according to previous studies. This variability is partly explained by the difficulty of the diagnosis due to confounding clinical, radiological, and biological signs between ABPA and cystic fibrosis. Many predictive development factors of ABPA in the context of cystic fibrosis have been reported, including respiratory function, personal or familial atopy, colonization with Pseudomonas Aeruginosa and age. As in non cystic fibrosis patients, the treatment requires systemic corticotherapy and itraconazole. ABPA is still often under diagnosed and should be evoked in the context of cystic fibrosis.     

变应性支气管肺曲霉菌病

曲霉菌 (ａｓｐｅｒｇｉｌｌｕｓ ,Ａｓｐ)属于子囊菌纲真正子囊菌亚纲 ,在自然界中广泛分布 ,易在空气、水、腐烂植物、植物护根、低矮潮湿环境、寝具和一些食物中存在 ,致人类疾病菌种包括烟曲霉 (Ａｓｐｆ)、黄曲霉、土曲霉、黑曲霉等。通常 ,Ａｓｐ不致病 ,一定条件下引起气道免疫变应性反应 ,导致支气管痉挛 ,但对肺组织无直接的侵袭 ,表现为变应性支气管肺曲霉菌病 (ＡＢＰＡ) ;对于免疫损伤机体 ,如脏器移植后使用大剂量免疫抑制剂 ,使Ａｓｐ成为致病原 ,沿着血管系统传播导致播散 ,直接侵袭血管引起血管侵袭性疾病 ,这种过程属于感…     

Allergic bronchopulmonary aspergillosis in an HIV-infected individual.

Aspergilloma and invasive aspergillosis have been reported in HIV-infected individuals. Allergic Bronchopulmonary Aspergillosis (ABPA) is a lung disease marked by a hypersensitivity response to inhaled aspergillus species, most commonly Aspergillus fumigatus (Af). This manifestation of Af has previously not been reported in HIV-infected individuals. We report a case of an HIV-infected individual with ABPA who presents with a subacute respiratory illness and new pulmonary infiltrates.     

Allergic bronchopulmonary aspergillosis in a cane-sugar mill.

Allergic bronchopulmonary aspergillosis is reported in two (1.5%) of 131 workers occupationally exposed to Aspergillus fumigatus at the U.D. Sugar Mills, Shamli. Twelve of the workers revealed Type I (9.2%) and three (2.8%) Type III skin hypersensitivity against with fungus. Serum preciptins were demonstrated in two out of 44 workers and positive sputum cultures in 26 out of 58 workers. It is suggested that constitutional predisposition of the host may be a more important factor than the extent of exposure to the fungus in the development of allergic bronchopulmonary aspergillosis.     

Allergic bronchopulmonary aspergillosis. Apropos of 30 cases

Thirty cases of allergic bronchopulmonary aspergillosis (ABPA) were treated between 1967 and 1981. Developing in patients with a history of chronic asthma (28 of the 30 cases), the initial manifestations of ABPA developed after long periods (an average of 29 years after the onset of the asthma). Chest radiography demonstrated recurrent labile infiltrates in 28 cases, segmental or lobar atelectasis in 7, and proximal bronchiectasis in 16 cases. A circulating eosinophilia was a constant finding, but this varied with time. Immunologic investigations gave positive skin tests, 19 of the 30 patients only presenting a cutaneous reaction delayed until the 6th hour. Total IgE, determined in 18 cases, varied between 600 and 9400 IU/ml (RIST), with identification of specific IgE for Aspergillus in all cases, though to varying degrees. Serial measurements of total IgE levels showed co-existence of an acute progression of the affection and elevated total IgE in 3 cases, but no correlation was found between serum IgE levels and the severity or chronicity of the disease. Physiopathologic features included immediate and partially delayed hypersensitivity to Aspergillus fumigatus. The frequency of ABPA during the course of mucoviscidosis suggests, by analogy, that a local factor may exist which favorizes Aspergillus fumigatus proliferation in patients with ABPA alone.     

Allergic bronchopulmonary aspergillosis in cystic fibrosis

The current standards of care for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis are presented. Recent studies have increased understanding of the inflammatory process that occurs in cystic fibrosis patients with allergic bronchopulmonary aspergillosis. This has resulted in more precise diagnostic criteria that facilitate more timely diagnosis and treatment of ABPA in these patients. In addition to traditional treatment with systemic corticosteroids, promising results have been documented with antifungal therapy.