Evaluation of allergic bronchopulmonary aspergillosis in patients with and without central bronchiectasis.
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder induced by Aspergillus species colonizing the bronchial tree. Thirty one patients fulfilling criteria of ABPA were evaluated in the present study. Eleven patients were diagnosed as ABPA-S (serological positive) and 20 patients as ABPA-CB (with central bronchiectasis). The two groups of patients were compared on the basis of clinical, serological, and radiographic observations. Serum anti Aspergillus fumigatus IgG was positive in 72% of cases of ABPA-S and 85% of ABPA-CB patients at the time of presentation. Specific IgE against A. fumigatus and total IgE were significantly lower in ABPA-S (specific IgE= 7.42 IU and total IgE= 1127 ng/mL) as compared to ABPA-CB (specific IgE = 44 IU and total IgE = 2874 ng/mL). The spirometric changes in ABPA-S (normal 80%, mild obstruction 10%, and severe obstruction 10%) were milder than in ABPA-CB (normal 40%, mild obstruction 10%, moderate obstruction 20%, and severe obstruction 30%). These patients were monitored closely for seasonal exacerbation with new pulmonary infiltrates which gave lower recordings in ABPA-S patients. No patient in the ABPA-S group progressed to end-stage lung disease. This may be due to early recognition and treatment. The present data suggest that ABPA-S represents the early stage of an apparently less aggressive form of ABPA than ABPA-CB.
Kumar
Raj
R
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, India. rajneel44@rediffmail.com
Chopra
Deepti
D
Chopra
Rajkumar Deepti
RD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D001987:Bronchiectasis / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D004804:Eosinophils; D005192:Family Health; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D007958:Leukocyte Count; D008875:Middle Aged; D012621:Seasons; D012882:Skin Tests