Fungi-Induced Upper and Lower Respiratory Tract Allergic Diseases: One Entity

Abstract

Introduction: Aspergillus can cause different allergic diseases including allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS). ABPA is allergic pulmonary disease against Aspergillus antigens. AFRS is a type of chronic rhinosinusitis (CRS) presented as hypersensitivity reactions to the fungal presence in sinuses. The aim of the present study was to clarify if ABPA and AFRS could be considered as a common disease entity.Methodology: The prospective cohort study included 75 patients with ABPA. Patients were divided into two groups and compared with each other: (i) patients with CT confirmation of rhinosinusitis and presence of fungi in sinuses (ABPA+AFRS group) and (ii) patients without CT or without mycological evidence of AFRS (ABPA group).Results: Findings of this study were: (i) AFRS was confirmed in 80% of patients with ABPA; (ii) all ABPA+AFRS patients had allergic mucin while fungal hyphae were present in 60% sinonasal aspirate; (iii) ABPA+AFRS patients had more often complicated CRS with (nasal polyps) NP (p < 0.001) and more severe forms of CRS; (iv) culture of sinonasal aspirate revealed fungal presence in 97% patients with ABPA+AFRS; (v) patients with ABPA+AFRS had more common positive skin prick test (SPT) for A. fumigatus (p = 0.037), while patients without AFRS had more common positive SPT for Alternaria alternata and Penicillium notatum (p = 0.04 and p = 0.03, respectively); (vi) 67% of ABPA patients had Aspergillus induced AFRS; (vii) larger number of fungi was isolated from the air-samples obtained from homes of patients with ABPA+AFRS than from the homes of patients without AFRS, while the most predominant species were A. fumigatus and A. niger isolated from almost 50% of the air-samples.Conclusion: The pathogenesis of ABPA and AFRS is similar, and AFRS can be considered as the upper airway counterpart of ABPA. Fungi-induced upper and lower respiratory tract allergic diseases present common entity. Next studies should clarify the mechanism by which fungi turn from “normal flora” into trigger of immunological reactions, resulting in ABPA or AFRS as well as to find new approaches for its' diagnosis and treatment.

Bacterial Profile and Antimicrobial Susceptibility of Isolates Recovered from Lower Respiratory Tract Infection for Patients in Rizgary Hospital, Erbil

“…Our data showed no bacterial growths in 5.3% of sputum and 14.61% of bronchial wash specimens (Table I). The undetectable bacterial growth might not reflect the absence of LRIs, as some LRIs cases are due to fungal or viral infections (Troeger, et al, 2019;Barac, et al, 2018). However, this suggestion was not conformed since the focus of this study was only on bacteria.…”

Mycological Profile of Respiratory Tract Samples in a Tertiary Care Hospital from Western India

“…Aspergillus species primarily affects the lungs causing upper and lower airway disorders. [12,13] Its spores are ubiquitous and present almost everywhere in the human environment, outdoor and indoor. [14] Among Aspergillus species, A. fumigatus was most commonly isolated followed by A. flavus in our study, this finding is similar to Farooq S et al related to mycological profile of LRTI.…”

Sinobronchial allergic mycosis syndrome in an elderly male

“…In one study of 95 patients with ABPA, diagnoses of definite and probable AFRS were reached in 7 (7%) and 13 (14%) patients, respectively [7], although their concurrence might be more frequent based on the “one airway, one disease” hypothesis. Another study reported that AFRS was confirmed in 80% with patients of ABPA [8]. The difference in the percentage of patients with concomitant ABPA and AFRS between the two studies might be partially explained by the differences in the diagnostic criteria for ABPA and AFRS.…”