Abstract
Dr. Hinson and his colleagues first described allergic bronchopulmonary aspergillosis (ABPA) in 1952. Later in 1977, Rosenberg proposed a diagnostic criteria for ABPA that even today remains widely acknowledged. Despite these steps taken, there still isn't a standardized diagnostic criteria set for ABPA although many have been proposed by various physicians over the years. ABPA is a condition caused by hypersensitivity to Aspergillus fumigatus antigens. It is seen most commonly in patients with either asthma or cystic fibrosis. In susceptible hosts, repeated inhalation of Aspergillus spores can cause an allergic response. Although a standardized diagnostic criteria is required, there is no single test that establishes the diagnosis other than a demonstration of central bronchiectasis (CB) with normal tapering bronchi, a feature that is still considered pathognomonic of ABPA. Because of lack of standardized diagnostic criteria and screening, even today ABPA is under diagnosed and often times treatment for it is delayed. This can lead to complications in patients like pulmonary fibrosis, bronchiectasis with chronic sputum production, and increasingly severe persistent asthma with loss of lung function. For this alone, it becomes imperative that the diagnostic criteria guidelines need to be reviewed and standardized preferably with the help of larger research studies. In the following review article, we address the epidemiology, pathophysiology, and the current cumulative view regarding the diagnosis of ABPA.
Highlights
BackgroundAspergillosis is a condition in which Aspergillus fungi infect tissues
The major criteria consisted of patients diagnosed with asthma, the presence of pulmonary opacities on chest radiographs, immediate cutaneous reactivity to Aspergillus fumigatus (Af), the serum immunoglobulin E (IgE) being more than 1000 IU/mL, precipitating antibodies against Af, peripheral blood eosinophilia, and central or peripheral bronchiectasis with normal tapering of distal bronchi [15,16]
The minimum criteria consists of patients with asthma or cystic fibrosis, worsening lung function, a positive skin prick test with Aspergillus species, a total serum IgE greater than 1000 ng/mL (416 IU/mL), increased Aspergillus species-specific IgE and immunoglobulin G (IgG) antibodies, and infiltrates noted on the chest radiograph [4]
Summary
Aspergillosis is a condition in which Aspergillus fungi infect tissues. Aspergillosis affecting the respiratory tract can have several manifestations that range from hypersensitivity disorders to rapidly invasive disseminated disease, all of which can be classified within three distinct categories [1,2]. Major Criteria: (1) asthma, (2) presence of fleeting or fixed pulmonary opacities on chest radiograph, (3) immediate cutaneous hypersensitivity reaction to Af, (4) total serum IgE elevated, more than 1000 IU/mL, (5) precipitating antibodies against Af, (6) peripheral blood eosinophilia, (7) central or proximal bronchiectasis with normal tapering of distal bronchi. The major criteria consisted of patients diagnosed with asthma, the presence of pulmonary opacities on chest radiographs, immediate cutaneous reactivity to Af, the serum IgE being more than 1000 IU/mL, precipitating antibodies against Af, peripheral blood eosinophilia, and central or peripheral bronchiectasis with normal tapering of distal bronchi [15,16]. The minimum criteria consists of patients with asthma or cystic fibrosis, worsening lung function, a positive skin prick test with Aspergillus species, a total serum IgE greater than 1000 ng/mL (416 IU/mL), increased Aspergillus species-specific IgE and IgG antibodies, and infiltrates noted on the chest radiograph [4]. They are the presence of IgG antibodies against Af, the presence of pulmonary opacities on chest radiograph, and lastly an eosinophil more than 500 cells/μL in steroid naïve patient [22]
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