Concurrent allergic bronchopulmonary aspergillosis and aspergilloma: is it a more severe form of the disease?

Abstract

The mould Aspergillus , a genus of spore forming fungi, affects the respiratory system in more ways than one. The clinical spectrum of Aspergillus involvement of the lungs ranges from various hypersensitivity manifestations to invasive disease which can be fatal. The inhaled spores hardly affect healthy persons but in asthmatic subjects these spores are trapped in the viscid secretions found in the airways. Repeated inhalation of Aspergillus antigens triggers allergic reactions in atopic individuals, which may manifest as Aspergillus -induced asthma, allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS) [1]. Saprobic colonisation of airways, cavities and necrotic tissue leads to the development of aspergillomas. Although ABPA is predominantly a disease of asthmatics, only a few asthmatics actually suffer from it. Contemporary reports suggest that ABPA occurs in up to 11% of patients with asthma [2–6]. The variable prevalence rates of ABPA in asthma may be attributable to the lack of a single diagnostic criterion and standardised tests [7]. A set of eight major and three minor criteria for the diagnosis of ABPA has evolved over time but minimal essential criteria have been identified: 1) asthma; 2) immediate cutaneous reactivity to A. fumigatus ; 3) total serum immunoglobulin (Ig)E >1,000 ng·mL−1; 4) elevated specific IgE- Af /IgG- Af ; and 5) central bronchiectasis in the absence of distal bronchiectasis [8]. This ‘picturesque’ disease causes a wide spectrum of chest radiographic appearances, which could be either transient or permanent [9]. The most characteristic transient changes are “fleeting …