Aspergillus/allergic bronchopulmonary aspergillosis in an Irish cystic fibrosis population: a diagnostically challenging entity.
BACKGROUND
Patients with cystic fibrosis (CF) can become colonized by aspergillus, which can act as an allergen and cause allergic bronchopulmonary aspergillosis (ABPA).


OBJECTIVE
To determine the rate of aspergillus colonization and ABPA in a population of Irish patients with CF.


METHODS
In 50 consecutive patients with CF who presented with exacerbations, we looked for the presence of aspergillus in their sputum and signs and symptoms of ABPA.


RESULTS
Fifteen patients (30%) grew aspergillus species in their sputum cultures. Six patients (12%) had ABPA. Matched for age, sex, genotype, and microbiology, there was no significant difference in forced expiratory volume in the first second (percent predicted, FEV(1)%) in subjects with aspergillus-positive sputum compared to those not colonized with aspergillus. Subjects with ABPA experienced sharp short-term deterioration in lung function (mean 6.7% predicted FEV(1)), which returned to baseline following at least 4 weeks of treatment.


CONCLUSIONS
The prevalence of ABPA was 12%. Aspergillus-positive sputum of itself was not a poor prognostic sign in terms of lung function over the 5-year study course. ABPA produces short-term reversible declines in lung function and responds to treatment. The frequency of aspergillus isolates did not correlate with the occurrence of ABPA. A low threshold for the diagnosis of ABPA should be maintained in any patient with CF who does not improve with antibiotics.
Chotirmall
Sanjay Haresh
SH
Department of Respiratory Medicine, Beaumont Hospital. Dublin 1, Republic of Ireland. sanjaychotirmall@hotmail.com
Branagan
Peter
P
Gunaratnam
Cedric
C
McElvaney
Noel Gerard
NG
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016022:Case-Control Studies; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007494:Ireland; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D013183:Sputum / Q000382:microbiology; D055815:Young Adult
D000935:Antifungal Agents; D005938:Glucocorticoids