Allergic Bronchopulmonary Aspergillosis

Allergic bronchopulmonary aspergillosis is an allergic lung disorder that often mimics pneumonia and is characterized by asthma, airway and lung inflammation with eosinophils (a type of white blood cell), and increased numbers of eosinophils in the blood. which occurs only in a minority of people with asthma, is characterized by wheezing, low-grade fever, and coughing up of brown-flecked masses or mucus plugs. Skin testing, blood tests, X-rays, and examination of the sputum for fungi can help establish the diagnosis. Allergic Bronchopulmonary Aspergillosis is characterized by pulmonary infiltrates, eosinophilia, elevated serum IgE and immediate type skin reactivity to aspergillus antigen. Allergic bronchopulmonary aspergillosis is seldom considered life-threatening. Allergic Bronchopulmonary Aspergillosis of fumigatus is responsible for a spectrum of lung diseases commonly grouped under the heading of aspergilloses .

The first adult with Allergic Bronchopulmonary Aspergillosis in the United States was described in 1968 , and the first childhood case was reported in 1970 . Since then, the increasing recognition of ABPA in children , adults, corticosteroid-dependent asthmatic patients, patients with cystic fibrosis (CF), and patients with allergic fungal sinusitis is probably the result of the increasing awareness by physicians of this complication of asthma or CF. Diagnosis has been helped by serologic aids such as total serum immunoglobulin E (IgE) , serum IgE, IgG antibodies to A. fumigatus, precipitating antibodies, and familiarity with chest radiography and high-resolution computed tomography (CT) findings. Some atypical patients seemingly have no documented history of asthma and present with chest roentgenographic infiltrates and peripheral blood eosinophilia

Cause of Allergic Bronchopulmonary Aspergillosis<

Here are the list of some of the causes of Allergic Bronchopulmonary Aspergillosis:

• The aspergillus fungus is common. It can grow on dead leaves, stored grain, bird droppings, compost stacks and other decaying vegetation.
• Although most people are frequently exposed to aspergillus, infections caused by it such as a pneumonia or fungus ball ( aspergilloma ) are rare.
• Patients with asthma or cystic fibrosis are at highest risk for allergic aspergillosis.

Symptoms of Allergic Bronchopulmonary Aspergillosis

Some commonly occuring symptoms are follows :

• The first indications of allergic bronchopulmonary aspergillosis are usually progressive symptoms of asthma, such as wheezing and shortness of breath, and a mild fever.
• The fungus itself, along with excess eosinophils, may be seen when the sputum is examined under the microscope.
• Wheezing
• Low-grade fever
• Coughing
• Coughing up brown-flecked masses or mucus plugs
• Unexplained worsening of asthma or cystic fibrosis

Diagnosis of Allergic Bronchopulmonary Aspergillosis

The criteria used for diagnosis of classic Allergic Bronchopulmonary Aspergillosis consist of five essential criteria and other criteria that may or may not be present, depending on the classification and stage of disease. The minimal essential criteria are

(a) asthma, even cough variant asthma or exercise-induced asthma;
(b) central (proximal) bronchiectasis;
(c) elevated total serum IgE ( ³ 1,000 ng/mL);
(d) immediate cutaneous reactivity to Aspergillus ; and
(e) elevated serum IgE and/or IgG antibodies to A. fumigatus . Central (proximal) bronchiectasis in the absence of distal bronchiectasis, as occurs in CF or chronic obstructive pulmonary disease, is virtually pathognomonic for Allergic Bronchopulmonary Aspergillosis.

Treatment of Allergic Bronchopulmonary Aspergillosis

Although the exact pathogenesis of Allergic Bronchopulmonary Aspergillosis is unknown, oral corticosteroids have been demonstrated to reduce the clinical symptoms, incidence of positive sputum cultures, and roentgenographic infiltrates. Oral corticosteroids may be effective by decreasing sputum volume, by making the bronchi a less suitable culture media for Aspergillus species, and by inhibiting many of the Aspergillus -pulmonary immune system interactions. Some importent treatment of Allergic Bronchopulmonary Aspergillosis:

• Antiasthma drugs also open up the airways, making it easier to cough up mucus plugs and clear out the fungus.
• The corticosteroid prednisone Some Trade Names are DELTASONE and METICORTEN
  taken initially in high doses and over a long period of time in lower doses may prevent progressive lung damage.
• Most specialists recommend oral corticosteroids; the inhaled kind has not been shown to work well for this condition.
• Allergic aspergillosis is treated with prednisone.
• The anti-fungal antibiotic itraconazole can also be helpful. People with asthma should also continue their usual treatments.

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