Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a disease that develops with hypersensitivity to aspergillus antigens. Mainly A. fumigatus. It usually occurs in people with asthma, cystic fibrosis. It is also higher in people with atopy.



Clinical manifestations
In ABPA, the lungs show reversibleobstructive changes, which, however, may progress to irreversible changes at more advanced stages. Restrictive lung disease with reduced diffusion capacity due to mucus and hyphal compression of the airways and central bronchiectasis (CB) develops.

ABPA is divided into five stages:
 * acute - initial phase characterized by asthma, elevated IgE levels, eosinophilia, pulmonary infiltrates and IgG and IgE antibodies against A. fumigatus;
 * remission phase - symptoms weakened (reduced);
 * exacerbation - rediscovery of initial symptoms, IgE level doubles;
 * phase occurring in patients with asthma dependent on regular use of corticosteroids - asthma worsens, causing bronchiectasis,
 * fibrotic phase - development of fibrosis in the upper lobes of the lungs.

Symptoms
Patients exhibit episodic wheezing, coughing up sputum with brown coatings, chest pain and fever.

Diagnostics
Diagnostic criteria for ABPA are asthma, immediate skin reactionto Aspergillus, presence of IgG and IgE against A. fumigatus in the blood, IgE level higher than1000 IU / ml, occurrence of pulmonaryinfiltrates on CT chest, eosinophilia (1000 cells / µl).

Treatment
Most cases require treatment with systemic corticosteroids. Corticosteroids (suppression of hypersensitivity and inflammatory responses). The drug of choice is mainly Prednisone. In some cases, Itraconazole is also used.

Related articles

 * Aspergillosis
 * Invasive aspergillosis
 * CNPA
 * Aspergilloma
 * Invasive fungal infections
 * Aspergillus infections

Literature

 * KOUSHA, M, R TADI a A.O SOUBANI. Pulmonary aspergillosis: a clinical review. European Respiratory review [online]. 2011, roč. 2011, vol. 20, no. 121, s. 156-162, dostupné také z . ISSN 1600-0617. DOI: 10.1183/09059180.00001011.
 * WILLEY, Joanne M, Linda M SHERWOOD a Christopher J WOOLVERTON, et al. Prescott,Harley, and Klein’s Microbiology. 7. vydání. New York : McGraw-Hill Hogher Education, 2008. 0 s. ISBN 978–0–07–299291–5.
 * EDITOR, Moselio, Moselio Schaechter; consulting SCHAECHTER a Joshua LEDERBERG. The desk encyclopedia of microbiology. - vydání. Amsterdam : Elsevier, 2004.  ISBN 0-12-621361-5.
 * KOUSHA, M, R TADI a A.O SOUBANI. Pulmonary aspergillosis: a clinical review. European Respiratory review [online]. 2011, roč. 2011, vol. 20, no. 121, s. 156-162, dostupné také z . ISSN 1600-0617. DOI: 10.1183/09059180.00001011.