Aspergillus - From Catholic ceremonies to invasive disease.

Abstract

In this article we discuss Allergic Bronchopulmonary Aspergillosis (ABPA), an inflammatory pulmonary condition caused by hypersensitivity to Aspergillus antigens, with Aspergillus fumigatus the most common cause. The estimated prevalence of ABPA in asthma is between 0.7% and 3.5%, with ∼ 4.8 million patients with ABPA globally. We further review the current understanding of the pathophysiology of ABPA which is characterized by a T helper 2 cell response (Th2) and the role of different innate and adaptive immune cells. Diagnosis is based on a combination of clinical, serological and radiological features with several proposed diagnostic criteria including the Rosenberg-Patterson criteria, and more recently the ISHAM (International Society for Human and Animal mycology) working group criteria. Classification was originally based radiologically on absence or presence of bronchiectasis, however a more recent classification system has been proposed by ISHAM to take into account the heterogeneous presentation of ABPA. Clinical management is currently focused on reducing environmental mold exposure, corticosteroids and oral azole antifungal agents. However, there is a lack of large-scale randomized controlled trials to provide a strong evidence base. With an increasing role of precision medicine based therapeutics, however, there is increased interest in the potential role for novel monoclonal antibody therapy targeting the host Th2 response.