Allergic bronchopulmonary aspergillosis in cystic fibrosis--state of the art: Cystic Fibrosis Foundation Consensus Conference.
Because of the difficulties of recognizing allergic bronchopulmonary aspergillosis (ABPA) in the context of cystic fibrosis (because of overlapping clinical, radiographic, microbiologic, and immunologic features), advances in our understanding of the pathogenesis of allergic aspergillosis, new possibilities in therapy, and the need for agreed-upon definitions, an international consensus conference was convened. Areas addressed included fungal biology, immunopathogenesis, insights from animal models, diagnostic criteria, epidemiology, the use of new immunologic and genetic techniques in diagnosis, imaging modalities, pharmacology, and treatment approaches. Evidence from the existing literature was graded, and the consensus views were synthesized into this document and recirculated for affirmation. Virulence factors in Aspergillus that could aggravate these diseases, and particularly immunogenetic factors that could predispose persons to ABPA, were identified. New information has come from transgenic animals and recombinant fungal and host molecules. Diagnostic criteria that could provide a framework for monitoring were adopted, and helpful imaging features were identified. New possibilities in therapy produced plans for managing diverse clinical presentations.
Stevens
David A
DA
Department of Medicine, Santa Clara Valley Medical Center, Stanford University Medical School, San Jose, California 95128-2699, USA. stevens@stanford.edu
Moss
Richard B
RB
Kurup
Viswanath P
VP
Knutsen
Alan P
AP
Greenberger
Paul
P
Judson
Marc A
MA
Denning
David W
DW
Crameri
Reto
R
Brody
Alan S
AS
Light
Michael
M
Skov
Marianne
M
Maish
William
W
Mastella
Gianni
G
D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D001232:Aspergillus fumigatus; D003226:Congresses as Topic; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology; D006801:Humans
D000935:Antifungal Agents