Clinical, radiological, and immunological assessment of allergic bronchopulmonary aspergillosis

Abstract

INTRODUCTION: Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated lung disease, predominantly in patients with asthma and is caused by hypersensitivity to colonized dimorphic fungus Aspergillus, commonly Aspergillus fumigatus. Early diagnosis with recognition and treatment of chest radiographic infiltrates appears to prevent progression to end stage fibrosis. Many cases are mistreated as pulmonary tuberculosis or recurrent pneumonia and are deferred for specific treatment of ABPA. AIM AND OBJECTIVES: This study aims to know the clinical, radiological, and immunological profile of patients diagnosed with ABPA reporting to the Institute of Respiratory Disease, SMS College, Jaipur and Mahatma Gandhi Medical College, Jaipur. MATERIALS AND METHODS: Hospital-based prospective, observational, cross-sectional study was conducted in 48 Patients having history of bronchial asthma, pulmonary infiltrate/shadows on chest X-ray were subjected to routine investigations, immunological tests including modified skin prick test with specific IgE against A. fumigatus and specific precipitins against A. fumigatus. RESULT: In this study, maximum predominance with age group of 21–40 years irrespective of sexpattern. Maximum patients were having bronchial asthma of 2–10 years duration. Cough, breathlessness, and wheezing were main clinical features. In 80% cases, total eosinophilic counts were more than 1000.58.4% sputum were fungal culture positive, maximum for A. fumigatus. All cases showed modified kinprick test positivity against A. fumigatus. Maximum patients high-resolution computed tomography chest had central bronchiectasis. 37% cases had raised total serum IgE (range 1000–5000). Specific IgE against A. fumigatus were positive in 24 patients. 87.5% patients were positive for specific precipitins. CONCLUSION: In this study, ABPA was found more commonly in people with chronic asthma of productive age group, i.e., 20–40 years and farmers by occupation. Most of the people were diagnosed as having pulmonary tuberculosis and deferred specific treatment for a long time. More knowledge about ABPA to physicians could possibly cut short the time between suffering, diagnosis, and proper treatment of these patients.

Keywords

• allergic bronchopulmonary aspergillosis
• aspergillus fumigatus
• bronchiectasis