This entity is most commonly encountered in patients with longstanding asthma , and only occasionally in patients with cystic fibrosis 4,5. Only rarely does it appear in patients with no other identifiable pulmonary illness 5. Clinically, patients have atopic symptoms especially asthma and present with recurrent chest infection. They may expectorate orange-colored mucous plugs.
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The journal accepts articles in Spanish or in English on the field of hospital medicine. The journal publishes original articles, clinical cases, reviews articles, history notes, issues on medical education, short communications and editorials at the invitation of the Society.
All articles are double blind peer reviewed by at least 2 reviewers and finally classified as accepted or rejected by the Editorial Board. Allergic bronchopulmonary aspergillosis ABPA is a pulmonary disorder caused by hypersensitivity mechanisms against antigens released by Aspergillus species, colonizing the airways.. We present the case of a year-old male with a history of asthma and allergic rhinoconjunctivitis with a history of 15 months of cough with purulent sputum, intermittent fever and dyspnea.
Thoracic tomography showed bronchiectasis accompanied by mucus impaction. He was treated with different antibiotics and steroid regimens, without a favorable clinical response. The presence of eosinophilia in the peripheral blood, immunoglobulin E Total, skin tests for Aspergillus positive guided the diagnosis of ABPA. Treatment with prednisone plus itraconazole was started, with remission of symptoms.. ABPA should be suspected in patients with asthma with poor response to treatment and alteration in radiologic studies.
Treatment includes systemic steroids and avoiding exposure to Aspergillus.. Allergic bronchopulmonary aspergillosis ABPA is a pulmonary disorder caused by a hypersensitivity mechanisms type I, III and IV against antigens released by Aspergillus species, colonizing the airways of patients mainly with asthma and cystic fibrosis CF.
In predisposed individuals, disease occurs following colonization of the bronchi by Aspergillus conidia. The fungal hyphae extend, and allergens are released, leading to persistent airway inflammation resulting in excessive viscous mucous production and impaired mucociliary function. ABPA is clinically characterized by poorly controlled asthma, recurrent pulmonary infiltrates, and bronchiectasis, in some cases can leading to pulmonary fibrosis.
In Mexico, its prevalence is unknown, however different case reports have been published. Most patients are less than 35 years old at the time of diagnosis. A 16 year old male patient with a previous diagnosis of asthma and allergic rhinoconjunctivitis since he was 6 years old, is evaluated in our department of allergy and immunology having history of 15 months of cough with purulent sputum, intermittent fever, progressive dyspnea and acrocianosis.
Six months after onset of symptoms he was hospitalized in pediatric unit for 2 months with diagnosis of pneumonia, treated with different antibiotics. The chest X-rays showed a reticular pattern accompanied by images suggesting bronchiectasis, computed tomography of the lungs confirmed central bronchiectasis, accompanied by mucoid impaction and reticular infiltrates see Figs. X-ray chest shows right posterior basal segmental atelectasis, the lungs present diffuse interstitial reticulum infiltrates, inflammatory infiltrates in the left lung base, bronchiectasis in principal and segmental bronchi, associated right pleural effusion.
In addition, right subdiaphragmatic intestinal loops Chilaiditi syndrome. Computed tomography of the chest, axial section with a window for pulmonary parenchyma in which atelectasis with mucus impaction is observed in the lower right lobe segments 7, 8 and Cystic bronchiectasis with mucus impaction in the left lower lobe segments 9 and Coronary reconstruction with window for pulmonary parenchyma in which consolidation is observed in the right upper lobe and parenchymal bands.
Atelectasis with mucus impaction in the right lower lobe. In the lower left lobe there is consolidation, thickening of the wall of the main bronchus. Due to poor response to treatment, were performed multiple studies among them: sputum smear microscopy in 3 determinations negative, tuberculin test negative, Chlorine test in the sweat Chlorimetry and conductivity two determinations negative, the flow cytometry and the nitroblue tetrazolium test were within normal limits, the immunoglobulins were not compatible with some pattern of Immunodeficiency, so it was ruled out that it was pulmonary tuberculosis, cystic fibrosis or some primary immunodeficiency.
An attempt was made to perform fiberoptic bronchoscopy but patient presented significant desaturation during the procedure, which impeded the conclusion of the procedure and take samples. He was discharged with mild clinical improvement and oxygen dependence, Nine months after discharge was evaluated in our service of allergy and immunology, were performed the following studies: Blood peripheral eosinophils 9.
Respiratory Functional Tests demonstrated a very severe flow obstruction without response to bronchodilator Albuterol with data suggesting pulmonary distention and increased resistance and severely decreased diffusion. With the clinical and laboratory data, we concluded that the patient had allergic bronchopulmonary aspergillosis stage 1. The patient was evaluated in a month and then every 2 months, at 6 months follow-up had significant clinical improvement.
He had suspended supplemental oxygen and returned to normal activities at home and at school. ABPA should be suspected in patients with asthma who have a poor response to usual treatment since an appropriate management can cause an impact on quality of life because ABPAs symptoms may be severe and leading to pulmonary fibrosis.
Aspergillus-related pulmonary disorders may be classified into four clinical categories depending on whether the host is atopic, non-atopic or immunosuppressed see Table 1 , 7 Invasive aspergillosis IA is seem in patients with severe neutropenia, allogeneic bone marrow transplantation, prolonged use of systemic steroids, treatment with immunosuppressants and primary immunodeficiency, our patient did not have any of these conditions.
Pulmonary aspergillosis clinical syndromes. ABPA is commonly caused by A. It is a Th2 hypersensitivity lung disease caused by bronchial colonization with A.
Additional criteria modified might include peripheral blood eosinophilia, Aspergillus species serum precipitating antibodies, central bronchiectasis, and Aspergillus species-containing mucus plugs 9—11 see Table 2. The case that we presented complied with the 5 criteria according to original criteria of Greenberger and Patterson, complying for both central bronchiectasis and for seropositive ABPA.
Criteria for the diagnosis of ABPA in patients with asthma. ABPA can be divided into five stages, each stage representing a different category of presentation Table 3. Determining the stage in which the patient is important for treatment and prognosis. The aim of treatment in ABPA is to reduce episodic acute inflammation, thus limiting disease progression with resultant airway destruction and both parenchymal and airway fibrosis.
To achieve this, a dual treatment approach is required: corticosteroids to control immunological activity and antifungal azole agents to suppress Aspergillus colonization and proliferation, which reduce antigenic stimulation, limiting further inflammation.
However, reviews have emphasized the weakness of the evidence for safety and efficacy of azoles, with only two small, short-term, randomized, double-blind, placebo-controlled trials in asthmatic ABPA, and none in cystic fibrosis ABPA. There are potential alternative approaches to antifungal treatment that avoid systemic effects, azole resistance and drugs interactions; Inhaled amphotericin B has been explored as an ABPA treatment with varying results in uncontrolled studies.
Finally, the success of omalizumab anti-IgE monoclonal antibody in improving control of moderate—severe allergic asthma has led to great interest and rapidly increasing usage in ABPA, usually undertaken as a steroid-sparing agent, with virtually unanimous reporting of reduced steroid requirements and exacerbations in published uncontrolled studies.
Our patient had a good response with combined treatment with prednisone and itraconazole, with clinical improvement. He stopped using supplemental oxygen and six months later of start treatment was able to return to previous physical activities. The authors declare that no experiments were performed on humans or animals for this study.
The authors declare that they have followed the protocols of their work center on the publication of patient data. The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document. The authors have no conflict of interests to declare. ISSN: See more Follow us:. Previous article Next article. Issue 3. Pages July - September Allergic bronchopulmonary aspergillosis in teenager with bronchial asthma.
Download PDF. Corresponding author. This item has received. Under a Creative Commons license. Received 13 February Accepted 08 May Show more Show less.
Table 1. Pulmonary aspergillosis clinical syndromes.. Table 2. Criteria for the diagnosis of ABPA in patients with asthma..
Allergic bronchopulmonary aspergillosis ABPA is a pulmonary disorder caused by hypersensitivity mechanisms against antigens released by Aspergillus species, colonizing the airways. Treatment with prednisone plus itraconazole was started, with remission of symptoms. Treatment includes systemic steroids and avoiding exposure to Aspergillus. Allergic bronchopulmonary aspergillosis. Palabras clave:. Introduction Allergic bronchopulmonary aspergillosis ABPA is a pulmonary disorder caused by a hypersensitivity mechanisms type I, III and IV against antigens released by Aspergillus species, colonizing the airways of patients mainly with asthma and cystic fibrosis CF.
Figure 1. Figure 2. Figure 3. Chronic necrotizing pulmonary aspergillosis. CT, computed tomography. Table 3. Stages of ABPA. Bains, M. Clin Chest Med, 33 , pp.
Matsuoka, T. Uzu, M. Koyama, et al. Allergic bronchopulmonary aspergillosis presenting with cough variant asthma with spontaneous remission. Respir Med CME, 4 , pp. Hogan, D. Allergic bronchopulmonary Aspergillosis and related allergic syndromes. Semin Respir Crit Care Med, 32 , pp. Velasco-Medina, D. Agarwal, A. Aggarwal, D.
2014, Número 2
Bains S, Judson M. Allergic bronchopulmonary aspergillosis. Clinics in Chest Medicine ; Atypical presentation of allergic bronchopulmonary aspergillosis: An unusual cause of difficult-to-treat asthma. J Family Med Prim Care ;
Allergic Bronchopulmonary Aspergillosis (ABP)
Allergic bronchopulmonary aspergillosis
Only comments seeking to improve the quality and accuracy of information on the Orphanet website are accepted. For all other comments, please send your remarks via contact us. Only comments written in English can be processed. A rare immunologic pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus , clinically manifesting with poorly controlled asthma and recurrent pulmonary infiltrates. ABPA is most commonly diagnosed in adults although it is increasingly being diagnosed in children. ABPA is an immunologic disorder due to a predominant T-helper 2 lymphocyte response to Aspergillus fumigatus infection without tissue invasion.
[Allergic Bronchopulmonary Aspergillosis]
The journal accepts articles in Spanish or in English on the field of hospital medicine. The journal publishes original articles, clinical cases, reviews articles, history notes, issues on medical education, short communications and editorials at the invitation of the Society. All articles are double blind peer reviewed by at least 2 reviewers and finally classified as accepted or rejected by the Editorial Board. Allergic bronchopulmonary aspergillosis ABPA is a pulmonary disorder caused by hypersensitivity mechanisms against antigens released by Aspergillus species, colonizing the airways..