Mild, moderate, and severe forms of allergic bronchopulmonary aspergillosis: a clinical and serologic evaluation.
BACKGROUND
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder induced by Aspergillus species colonizing the bronchial tree. There are patients with asthma who fulfill the diagnostic criteria of ABPA by serologic evaluation (specific IgE/IgG to Aspergillus fumigatus), bronchography, CT, and or conventional linear tomography.


OBJECTIVE
To identify different forms of ABPA based on various diagnostic criteria.


METHODS
Eighteen patients with asthma fulfilling the criteria of ABPA were evaluated in the present study. Six patients each received a diagnosis of ABPA serologic positive (ABPA-S), ABPA with central bronchiectasis (ABPA-CB), and ABPA with central bronchiectasis and other radiologic features (ABPA-CB-ORF).


RESULTS
The spirometric changes in the ABPA-S group (group 1) were mild, in the ABPA-CB group (group 2) were moderate, and in the ABPA-CB-ORF group (group 3) were severe. Absolute eosinophil count was raised in each group but was maximum (1,233 micro L) in severe form of disease (group 3). Specific IgE against A fumigatus was raised in each group, and the maximum was 47.91 IU/mL in ABPA-CB-ORF. CT scan findings of the ABPA-S group were normal without central bronchiectasis. The exacerbation in symptoms was maximum in group 3 compared to other groups.


CONCLUSIONS
The present observations suggest that ABPA includes mild (ABPA-S), moderate (ABPA-CB), and severe (ABPA-CB-ORF) forms of disease. It is recommended, therefore, that the disease should be diagnosed early, treated at the mild form of disease (ABPA-S), and prevented from leading to ABPA-CB or ABPA-CB-ORF.
Kumar
Raj
R
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, 44/1 Probyn Road, Delhi-7, India. rajneel44@rediffmail.com
D000293:Adolescent; D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood*; D000918:Antibody Specificity / Q000276:immunology; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000145:classification / Q000175:diagnosis* / Q000276:immunology; D001232:Aspergillus fumigatus / Q000276:immunology*; D001249:Asthma / Q000145:classification / Q000175:diagnosis / Q000276:immunology; D001987:Bronchiectasis / Q000145:classification / Q000175:diagnosis / Q000276:immunology; D001995:Bronchography; D002648:Child; D018450:Disease Progression; D004804:Eosinophils / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007074:Immunoglobulin G / Q000097:blood*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D013147:Spirometry; D014057:Tomography, X-Ray Computed
D000908:Antibodies, Fungal; D007074:Immunoglobulin G; D007073:Immunoglobulin E