Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

Agarwal, Ritesh; Khan, Ajmal; Garg, Mandeep; Aggarwal, Ashutosh N.; Gupta, Dheeraj

doi:10.4329/wjr.v4.i4.141

Cited by 59 publications

(59 citation statements)

References 45 publications

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“…Bronchiectasis has been considered as the sine qua non for the diagnosis of ABPA . However, bronchiectasis is encountered in asthma also with a frequency ranging from 27 to 68%, and the prevalence of bronchiectasis is even higher in those with AFAA . Thus, bronchiectasis is a poor discriminator between ABPA and AFAA.…”

Section: Discussionmentioning

confidence: 99%

Role of Aspergillus fumigatus‐specific IgG in diagnosis and monitoring treatment response in allergic bronchopulmonary aspergillosis

Agarwal

Dua

Choudhary

et al. 2016

Mycoses

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Few studies have evaluated the utility of Aspergillus fumigatus-specific IgG in allergic bronchopulmonary aspergillosis (ABPA). Herein, we evaluate the role of specific IgG in diagnosis and monitoring treatment response in ABPA. Forty-eight control subjects with A. fumigatus-associated asthma underwent A. fumigatus-specific IgG measurements at baseline, while specific IgG was assayed in 102 treatment-naïve subjects of ABPA at baseline, after eight weeks of glucocorticoid therapy, and during exacerbations. For determining the cut-off of A. fumigatus-specific IgG, we randomly classified two-thirds of the study subjects (cases and controls) as the derivation cohort, while the remaining one-thirds were labelled as the validation cohort. The best cut-off value of A. fumigatus-specific IgG in the derivation cohort was 26.9 mg /L (sensitivity: 88%; specificity: 100%). Using this limit, the sensitivity and specificity of A. fumigatus-specific IgG in diagnosis of ABPA was 89% and 100%, respectively, in the validation cohort. In contrast, the sensitivity of Aspergillus precipitins was only 27.4%. Following treatment, the A. fumigatus-specific IgG increased in 38 (37.2%) subjects, while it decreased in three (23.1%) of the 13 subjects experiencing an exacerbation. The A. fumigatus-specific IgG was found to be an extremely useful test in the diagnosis and differential diagnosis of ABPA but is unreliable in monitoring treatment response in this disorder.

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Section: Discussionmentioning

confidence: 99%

Role of Aspergillus fumigatus‐specific IgG in diagnosis and monitoring treatment response in allergic bronchopulmonary aspergillosis

Agarwal

Dua

Choudhary

et al. 2016

Mycoses

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“…We, and others, have shown an association between IgE sensitisation to A. fumigatus , fixed airflow obstruction and bronchiectasis . In addition, other radiological abnormalities including fleeting shadows, high attenuation mucus and lung fibrosis are a consistent feature of the clinical descriptions of fungal allergy in asthma . It remains unclear how the immunological biomarkers that are used to diagnose ABPA relate to specific disease outcomes in terms of lung damage, and whether they clearly identify those with fungal allergy that are at risk of disease progression.…”

Section: Introductionmentioning

confidence: 87%

The relationship between biomarkers of fungal allergy and lung damage in asthma

Woolnough

Richardson

Newby

et al. 2016

Clin Experimental Allergy

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SummaryBackground Immunological biomarkers are the key to the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and fungal sensitisation, but how these relate to clinically relevant outcomes is unclear. Objectives To assess how fungal immunological biomarkers are related to fixed airflow obstruction and radiological abnormalities in moderate to severe asthma. Methods Cross-sectional study of 431 asthmatics. Inflammatory biomarkers, lung function and an IgE fungal panel to colonising filamentous fungi, yeasts and fungal aeroallergens were measured. CT scans were scored for the presence of radiological abnormalities. Factor analysis informed the variables used in a k-means cluster analysis. Fixed airflow obstruction and radiological abnormalities were then mapped to these immunological variables in the cluster analysis. Results 329 (76.3%) subjects were sensitised to ≥ 1 fungi. Sensitisation to Aspergillus fumigatus and/or Penicillium chrysogenum was associated with a lower post-bronchodilator FEV 1 compared with those not sensitised to fungi ((73.0 (95% CI 70.2-76) vs. 82.8 (95% CI 78.5-87.2)% predicted, P < 0.001), independent of atopic status (P = 0.005)), and an increased frequency of bronchiectasis (54.5%, P < 0.001), tree-in-bud (18.7%, P < 0.001) and collapse/consolidation (37.5%, P = 0.002). Cluster analysis identified three clusters: (i) hypereosinophilic (n = 71, 16.5%), (ii) high immunological biomarker load and high frequency of radiological abnormalities (n = 34, 7.9%) and (iii) low levels of fungal immunological biomarkers (n = 326, 75.6%). Conclusions and Clinical Relevance IgE sensitisation to thermotolerant filamentous fungi, in particular A. fumigatus but not total IgE, is associated with fixed airflow obstruction and a number of radiological abnormalities in moderate to severe asthma. All patients with IgE sensitisation to A. fumigatus are at risk of lung damage irrespective of whether they meet the criteria for ABPA.

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“…Central bronchiectasis is a characteristic indicator for the diagnosis of ABPA, but lung lesions do not usually appear in patients in the early phase of ABPA; moreover, about 50% of patients with ABPA do not have significantly changes on imaging examination [20]. Of the 7 patients with ABPA in this study, 5 were clinically misdiagnosed as having asthma instead of being diagnosed as having ABPA-S, which was the final accurate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Role of <b><i>Aspergillus fumigatus-</i></b>Specific IgE in the Diagnosis of Allergic Bronchopulmonary Aspergillosis

Liu

Xu²,

Yang

et al. 2019

Int Arch Allergy Immunol

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Introduction: Allergic bronchopulmonary aspergillosis (ABPA) has been regarded as a rare disease in China due to the lack of quantitative detection of Aspergillus fumigatus-specific IgE (sIgE). We compared the diagnostic rate of ABPA among asthma patients with or without A. fumigatus-sIgE screening tests to evaluate the benefit of the tests in diagnosing ABPA. Methods: We reviewed the detection rate of A. fumigatus-sIgE and the diagnostic rate of ABPA in 1842 asthma patients in the First Affiliated Hospital of Zhejiang University from 2014 to 2016. Additionally, we collected 144 asthma cases from November 2016 to March 2017 to detect the total serum IgE, A. fumigatus-sIgE and sIgE against mixed mold extract, the ABPA diagnostic rate of these patients was then compared with the total cohort. Total serum IgE, A. fumigatus-sIgE and sIgE against mixed mold extract were also tested in 30 patients identified with Aspergillus-positive sputum culture to analyze the incidence of ABPA. Results: Among the 1,842 asthma cases, 566 were inspected for total IgE; 308 (55.40%) were total IgE-positive and 58 (10.43%) had total IgE > 1,000 IU/mL. In contrast, only 126 cases were tested for A. fumigatus-sIgE (6.84%), and 28 had A. fumigatus-sIgE > 0.35 kUA/L (22.22%). Eleven patients were finally diagnosed with ABPA. Of 1,842 asthma patients, only 0.6% were diagnosed with ABPA if the A. fumigatus-sIgE was not detected at first. Moreover, among the 144 asthma cases that were selected for total IgE, A. fumigatus-sIgE, and sIgE against mixed mold extract screening tests, 12 had total IgE > 1,000 IU/mL (8.33%), 11 had A. fumigatus-sIgE > 0.35 kUA/L (7.64%), and 14 had sIgE against mixed mold extract > 0.35 (9.72%); 7 of these patients were confirmed as having ABPA according to the ISHAM guidelines (4.86%) but only 2 without A. fumigatus-sIgE screening test were diagnosed with ABPA (1.39%) (p = 0.000). Of the 30 Aspergillus-positive sputum culture cases, 4 had A. fumigatus-sIgE > 0.35 kUA/L (13.33%), but none was diagnosed with ABPA. Conclusions: Routine A. fumigatus-sIgE screening for asthma patients can significantly improve the diagnostic rate of ABPA.

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Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

Cited by 59 publications

References 45 publications

Role of Aspergillus fumigatus‐specific IgG in diagnosis and monitoring treatment response in allergic bronchopulmonary aspergillosis

Role of Aspergillus fumigatus‐specific IgG in diagnosis and monitoring treatment response in allergic bronchopulmonary aspergillosis

The relationship between biomarkers of fungal allergy and lung damage in asthma

Role of <b><i>Aspergillus fumigatus-</i></b>Specific IgE in the Diagnosis of Allergic Bronchopulmonary Aspergillosis

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