Clinical Significance of Hyperattenuating Mucoid Impaction in Allergic Bronchopulmonary Aspergillosis

Agarwal, Ritesh; Gupta, Dheeraj; Aggarwal, Ashutosh N.; Saxena, Akshay Kumar; Chakrabarti, Arunaloke; Jindal, Surinder K.

doi:10.1378/chest.07-0808

Cited by 199 publications

(192 citation statements)

References 22 publications

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“…Hospital (Jaipur, Rajasthan) reported the prevalence of ABPA in asthmatic patients as 2.7% in contrast to the prime studies conducted so far in India like by Kumar and Gaur, Maurya et al, Agarwal et al, and Agarwal et al with a higher prevalence of ABPA of 16%, 7.5%, 27.2%, and 20.5% respectively. [3][4][5][6] Our study found lower prevalence (2.7%) in north western part of India which may due to drier environmental conditions as compared to rest of the sub continent. As it has been known that dryness in environment does not favour fungal allergen habitant, which may contribute to lower prevalence.…”

Section: Discussionmentioning

confidence: 68%

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Prevalence of Allergic Broncho Pulmonary Aspergillosis in patients with Asthma attending allergy clinic in a North West Indian Tertiary Care Institute

Mathur

2016

Int J of Biomed & Adv Res

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Context: Allergic Broncho Pulmonary Aspergillosis (ABPA) is an allergic disorder. Aspergillus fumigatus is the most common pathogen responsible for occurrence of ABPA. There can be serious consequences of ABPA including worsening of symptoms of asthma and more sinister complications like extensive fibrosis and bronchiectasis. Aims: To find out the prevalence of ABPA among asthma patients and association of former with factors like age, sex, occupation, family history of bronchial asthma, socioeconomic status and other relevant factors. Settings and Design: This study was a descriptive type of observational study conducted at our tertiary care institute. Methods and Material: Three hundred severe asthmatic patients underwent skin prick test (SPT) for five Aspergillus species. Four tests were applied to all SPT positive patients -Total serum IgE, spirometry, chest x-ray and High-resolution Computed Tomography (HRCT) scan of thorax. The diagnosis of ABPA was made when the patient fulfilled at least three out of four criteria. Results: Out of 300 severe asthmatic patients 27 (9%) patients were found SPT positive. Out of these 27 SPT positive patients, four patients refused for further investigations, and 23 were investigated further. Out of 23 SPT positive patients, eight patients (2.7%) were diagnosed as ABPA. It was also found that two out of eight patients with ABPA were misdiagnosed and treated earlier as pulmonary tuberculosis. Conclusions: All patients with bronchial asthma should be screened for ABPA by skin test for Aspergillus. There is need to implement screening programme and meticulous approach by physicians to diagnose and treat such patients. Key Messages: A diagnosis of allergic bronchopulmonary aspergillosis should be considered in patients coming with asthma. Skin prick test can be used to screen such patients. A further workup of the skin test positive patients leads to a high diagnostic yield.

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Section: Discussionmentioning

confidence: 68%

“…[1][2][3] There seems to be marked local variations as studies from different regions of India report a difference of many folds in the results. [3][4][5][6][7][8] Fungi are more prone to grow in wet and humid environment. Based on availability of water, the state of Rajasthan is considered dry as compared to the rest of India.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Allergic Broncho Pulmonary Aspergillosis in patients with Asthma attending allergy clinic in a North West Indian Tertiary Care Institute

Mathur

2016

Int J of Biomed & Adv Res

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“…(42,43) Mucoid impaction is defined as highly attenuated when the mucus density is higher than the skeletal muscle density. (41,44) High-attenuation mucoid impaction is also pathognomonic of ABPA and was into septate hyphae (7-10 μm) with 45º ramifications. Approximately 25% of asthma patients have positive immediate skin test reactivity to Aspergillus sp., which does not indicate ABPA but does indicate sensitization.…”

Section: Allergic Bronchopulmonary Aspergillosismentioning

confidence: 99%

“…(44) Such impaction is attributed to the presence of calcium salts, metals (iron and magnesium) or products of hemorrhage in the impacted mucus. It is the same base as that of the finding of fungal sinusitis.…”

Section: Allergic Bronchopulmonary Aspergillosismentioning

confidence: 99%

Eosinofilia pulmonar

Campos

Pereira

2009

J. bras. pneumol.

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Pulmonary eosinophilia comprises a heterogeneous group of diseases defined by eosinophilia in pulmonary infiltrates (bronchoalveolar lavage fluid) or in tissue (lung biopsy specimens). Although the inflammatory infiltrate is composed of macrophages, lymphocytes, neutrophils and eosinophils, eosinophilia is an important marker for the diagnosis and treatment. Clinical and radiological presentations can include simple pulmonary eosinophilia, chronic eosinophilic pneumonia, acute eosinophilic pneumonia, allergic bronchopulmonary aspergillosis and pulmonary eosinophilia associated with a systemic disease, such as in Churg-Strauss syndrome and hypereosinophilic syndrome. Asthma is frequently concomitant and can be a prerequisite, as in allergic bronchopulmonary aspergillosis and Churg-Strauss syndrome. In diseases with systemic involvement, the skin, the heart and the nervous system are the most affected organs. The radiological presentation can be typical, or at least suggestive, of one of three types of pulmonary eosinophilia: chronic eosinophilic pneumonia, acute eosinophilic pneumonia and allergic bronchopulmonary aspergillosis. The etiology of pulmonary eosinophilia can be either primary (idiopathic) or secondary, due to known causes, such as drugs, parasites, fungal infection, mycobacterial infection, irradiation and toxins. Pulmonary eosinophilia can be also associated with diffuse lung diseases, connective tissue diseases and neoplasia.Keywords: Pulmonary eosinophilia; Hypereosinophilic syndrome; Aspergillosis, allergic bronchopulmonary; Churg-Strauss syndrome. ResumoAs formas de eosinofilia pulmonar constituem um grupo heterogêneo definido pela presença de um ou dois critérios: infiltrado pulmonar com eosinofilia sanguínea e/ou eosinofilia tissular caracterizada por eosinófilos demonstrados na biópsia pulmonar ou no lavado broncoalveolar. Embora o infiltrado inflamatório seja composto de macrófagos, linfócitos, neutrófilos e eosinófilos, a presença de eosinofilia é um marcador importante para o diagnóstico e tratamento. A apresentação clínica e radiológica pode revelar eosinofilia pulmonar simples, pneumonia eosinofílica crônica, pneumonia eosinofílica aguda, aspergilose broncopulmonar alérgica e eosinofilia pulmonar associada à doença sistêmica, como na síndrome de Churg-Strauss e na síndrome hipereosinofílica. A asma está frequentemente associada, podendo ser um pré-requisito, como na aspergilose broncopulmonar alérgica e na síndrome de Churg-Strauss. Nas doenças com acometimento sistêmico, a pele, o coração e o sistema nervoso são os órgãos mais comprometidos. A apresentação radiológica pode ser considerada como típica, ou pelo menos sugestiva, para três formas de eosinofilia pulmonar: pneumonia eosinofílica crônica, aspergilose broncopulmonar alérgica e pneumonia eosinofílica aguda. A etiologia da eosinofilia pulmonar pode ser de causa primária (idiopática) ou secundária, compreendendo causas conhecidas, como drogas, parasitas, infecções por fungos e micobactérias, irradiação e toxinas. A eosinof...

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“…The rationale behind the use of steroids in ABPA exacerbations is their ability to relieve airway obstruction, decrease sputum production and hasten resolution of pulmonary infiltrates due to their anti-inflammatory effects (inhibition of phospholipase A2 activity and arachidonic acid metabolism, decrease in inflammatory cell chemotaxis, cell adhesion and tissue infiltration, and diminished production of inflammatory cytokines) [14]. We have previously shown that the presence of severe bronchiectasis and high-attenuation mucus is associated with recurrent relapses [15][16][17]. Both our patients had severe bronchiectasis while one patient had high-attenuation mucus.…”

Section: Pulse Methylprednisolone In Allergic Bronchopulmonary Aspergmentioning

confidence: 99%

Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations

Sehgal

Agarwal

2014

European Respiratory Review

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Clinical Significance of Hyperattenuating Mucoid Impaction in Allergic Bronchopulmonary Aspergillosis

Cited by 199 publications

References 22 publications

Prevalence of Allergic Broncho Pulmonary Aspergillosis in patients with Asthma attending allergy clinic in a North West Indian Tertiary Care Institute

Prevalence of Allergic Broncho Pulmonary Aspergillosis in patients with Asthma attending allergy clinic in a North West Indian Tertiary Care Institute

Eosinofilia pulmonar

Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations

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