Development of chronic pulmonary aspergillosis in adult asthmatics with ABPA.
BACKGROUND
Chronic pulmonary aspergillosis (CPA) is an occasional complication of allergic bronchopulmonaryaspergillosis (ABPA) but the transition is poorly understood.


METHODS
All patients referred to the UK's National Aspergillosis Centre with CPA between May 2009 and June 2012 were screened with serum total IgE and anti-Aspergillus IgE for a dual diagnosis of ABPA and CPA. Those patients suspected of having both conditions were re-evaluated and their imaging reviewed.


RESULTS
Of 407 referred patients, 42 screened positive and 22 were confirmed as having both ABPA and CPA. Asthma was present from early childhood in 19 (86%), the median interval between ABPA and onset of CPA was 7.5 years; one patient developed ABPA and CPA simultaneously. Aspergillus IgG levels varied from 23 to 771 mg/L, median 82 mg/L. All 22 patients had bronchiectasis. In patients with ABPA, CT typically demonstrated varicose or cystic bronchiectasis primarily affecting segmental and proximal subsegmental upper lobe bronchi. Other findings included mucoid impaction and centrilobular nodules. Radiological changes associated with CPA included pleural thickening which was often bilateral and accentuated by adjacent hypertrophied extrapleural fat, upper lobe volume loss, thick walled apical cavities, some of which contained aspergillomas, and cavitating pulmonary nodules. CPA secondary to ABPA has more subtle radiological appearances than when due to other underlying diseases.


CONCLUSIONS
CPA may complicate ABPA and have distinct radiology features, in addition to bronchiectasis. A novel biomarker is required to anticipate this serious complication, as current serology is not specific enough.
The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
David
D
Lowes
The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Livingstone
L
Chishimba
Department of Radiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
Melanie
M
Greaves
The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Electronic address: ddenning@manchester.ac.uk.
David W
DW
Denning
D000293:Adolescent; D000328:Adult; D000368:Aged; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000473:pathology; D001249:Asthma / Q000150:complications* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018450:Disease Progression; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000150:complications* / Q000473:pathology; D011658:Pulmonary Fibrosis / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D055815:Young Adult
Aspergillus fumigatus; Cavitation; Corticosteroids; Fibrosis; Fungal diseases