Case Of Allergic Bronchopulmonary Aspergillosis Research Articles

A challenge in diagnosis and treatment in asthma patients with allergic bronchopulmonary aspergillosis: a review

Allergic bronchopulmonary aspergillosis (ABPA) is a common form of fungal-related asthma disease mainly caused by Aspergillus fumigatus. The increasing prevalence of asthma globally and the characteristic of Aspergillus are very easily dispersed in the air to inhale, leading to increased cases of ABPA in asthma patients. Inhalation of conidia Aspergillus spp. can trigger asthma exacerbations due to poor mucociliary clearance. However, the exact pathogenesis is still unclear. Clinical features commonly found in ABPA patients are productive cough with dark green or brown mucus or even hemoptysis. Several criteria for establishing the diagnosis of ABPA can be based on clinical features, laboratory examinations, and imaging, but none has become the gold standard. However, the primary laboratory test utilized for ABPA screening is the measurement of serum-specific IgE levels to A. fumigatus, owing to its high sensitivity. Despite the challenges in finding the most fitting universal consensus, most clinicians still follow the criteria proposed by Rosenberg et al. in 1977. The recommended ABPA treatment is prednisone and/or azole antifungal agents such as itraconazole. In addition, the potential of monoclonal antibodies in ABPA therapy is still under further research. Long-term diagnosis and treatment delays can lead to complications such as bronchiectasis and fibrosis. This review aimed to highlight ABPA in asthma patients, from etiopathogenesis to managing the disease

A case of allergic bronchopulmonary aspergillosis in a child: Response to dupilumab

A case of allergic bronchopulmonary aspergillosis in a child: Response to dupilumab

Case Report: Allergic bronchopulmonary aspergillosis in a 21-year-old female patient with no prior asthma

Hypersensitivity brought on by Aspergillus causes a lung illness known as allergic bronchopulmonary aspergillosis (ABPA). ABPA is a common fungal disease that affects individuals with uncontrolled asthma, cystic fibrosis, and immunocompromised patients. Aspergillus mould species are highly prevalent in the environment, especially in organic waste. There are more than a hundred different species of Aspergillus throughout the world, but the most common offenders are Aspergillus fumigatus, Aspergillus niger, Aspergillus flavus, and Aspergillus clavatus. Several Aspergillus species, most notably Aspergillus fumigatus, are responsible for human diseases. Depending on the amount and virulence of inhaled Aspergillus and the host’s genetic vulnerability and immunity, Aspergillus can produce allergic or allergic (Aspergillus-mediated allergies and asthma, hypersensitivity pneumonia, and ABPA pulmonary disorders. Because of its unique appearance, particularly when there is no medical history of asthma, it may be challenging to diagnose in some circumstances. Although side effects from treating ABPA are regularly described, cumulative medication toxicity caused by several compounds is uncommon. It’s essential to make a wise decision among the several compounds that are available and efficient against ABPA. We document a case of ABPA in a female patient who had no prior history of asthma. She had complained about having trouble breathing. The presence of specific IgE antibodies against Aspergillus fumigatus & an elevated eosinophil count were used to make the diagnosis of ABPA.

Fungal infections in Sudan: An underestimated health problem.

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.

Real-world efficacy of anti-IL-5 treatment in patients with allergic bronchopulmonary aspergillosis

Despite standard treatment with systemic corticosteroids and/or antifungal triazoles, a substantial proportion of patients with allergic bronchopulmonary aspergillosis (ABPA) experience frequent relapses and require long-term treatment despite unfavorable adverse effects. We investigated the efficacy and safety of anti-interleukin (IL)-5/IL-5 receptor α chain (Rα) monoclonal antibodies (mAbs) in patients with ABPA complicated by asthma. ABPA cases treated with anti-IL-5/IL-5Rα mAbs were collected from 132 medical institutes in 2018 and published case reports in Japan. Clinical outcomes, laboratory and physiological data, and radiographic findings during 32 weeks before and after treatment were retrospectively evaluated. We analyzed 29 cases of ABPA: 20 treated with mepolizumab and nine with benralizumab. Treatment with anti-IL-5/IL-5Rα mAbs reduced the frequency of exacerbations (p = 0.03), decreased the dose of oral corticosteroids (p < 0.01), and improved pulmonary function (p = 0.01). Mucus plugs in the bronchi shrank or diminished in 18 patients (82%). Despite the clinical/radiographical improvement, serum levels of total IgE, the key biomarker for the pharmacological response in ABPA, were unchanged. Anti-IL-5/IL-5Rα mAbs that directly target eosinophils are promising candidates for the treatment of patients with ABPA, especially those with mucus plugs in the bronchi.

A case of allergic bronchopulmonary aspergillosis complicated by nocardiosis and staphylococcus aureus infection

Nocardia is a ubiquitous organism and often causes serious fatal infections in immuno-compromised individuals. Staphylococcus aureus infection stimulates an inflammatory response that causes lung damage and facilitates subsequent chronic infection. Patients of allergic bronchopulmonary aspergillosis (ABPA) on steroids and immunosuppressants are particularly at risk of these infections. We present the case of a middle-aged man who was diagnosed to have ABPA by serological and radiographic criteria. He presented with fever, cough, and mucopurulent sputum. Subsequent sputum culture for bacteria and fungus revealed the growth of Staphylococcus aureus and Nocardia spp. respectively.

Allergic Bronchopulmonary Aspergillosis in Children Presenting as Lung Masses.

Allergic bronchopulmonary aspergillosis (ABPA) is an IgE-mediated hypersensitivity reaction predominantly occurring in patients of asthma and cystic fibrosis. The typical radiological findings in ABPA include central bronchiectasis and fleeting opacities. In this retrospective study, the aim was to describe cases of ABPA in children who had a mass-like lesion in the lung. There were 5 cases of ABPA in children, who presented as mass-like lesions that responded very well to treatment for ABPA. All cases, except 1, had asthma as the underlying disease. There was a delay in the diagnosis of ABPA in all 5 cases. There had been unnecessary invasive investigations in some of these cases before the diagnosis of ABPA was made. To conclude, children with ABPA may present with a mass-like lesion in the lung and high index of suspicion is required to diagnose ABPA timely to prevent its consequences.

Report of 2 Cases of Allergic Bronchopulmonary Aspergillosis

To review the clinical data of two patients with allergic bronchopulmonary aspergillosis (ABPA) and to review the literature so as to improve the understanding of the disease and reduce misdiagnosis and missed diagnosis [1-6].

A Case of Allergic Bronchopulmonary Aspergillosis that Improved with Endoscopic Sinus Surgery for Fungal Sinusitis

A Case of Allergic Bronchopulmonary Aspergillosis that Improved with Endoscopic Sinus Surgery for Fungal Sinusitis

A rare case of allergic bronchopulmonary aspergillosis with allergic fungal rhinosinusitis masquerading as granulomatous vasculitis

A rare case of allergic bronchopulmonary aspergillosis with allergic fungal rhinosinusitis masquerading as granulomatous vasculitis

Allergic bronchopulmonary aspergillosis misdiagnosed as pneumonia

Allergic bronchopulmonary aspergillosis (ABPA) is a fungal infection of lung predisposing in long-standing bronchial asthma and cystic fibrosis patients. Due to its similar clinical and radiological findings of other pulmonary diseases such as pulmonary tuberculosis and pneumonia, ABPA is commonly misdiagnosed. The usage of anti-tubercular drugs for ABPA is exploited due to misdiagnosis. We illustrate a case of ABPA, which was misdiagnosed to be pneumonia.

Evaluation of the LDBio Aspergillus ICT lateral flow assay for serodiagnosis of allergic bronchopulmonary aspergillosis.

Early recognition and diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is critical to improve patient symptoms, and antifungal therapy may prevent or delay progression of bronchiectasis and development of chronic pulmonary aspergillosis. A recently commercialized lateral flow assay (Aspergillus ICT) (LDBio Diagnostics, Lyons, France) detects Aspergillus-specific antibodies in <30 minutes, requiring minimal laboratory equipment. We evaluated this assay for diagnosis of ABPA compared to diseased (asthma and/or bronchiectasis) controls. ABPA and control sera collected at the National Aspergillosis Centre (Manchester, UK) and/or from the Manchester Allergy, Respiratory and Thoracic Surgery research biobank were evaluated using the Aspergillus ICT assay. Results were read both visually and digitally (using a lateral flow reader). Serological Aspergillus-specific IgG and IgE, and total IgE titres were measured by ImmunoCAP. For 106 cases of ABPA versus all diseased controls, sensitivity and specificity for the Aspergillus ICT were 90.6% and 87.2%, respectively. Sensitivity for 'proven' ABPA alone (n = 96) was 89.8%, and 94.4% for 'presumed' ABPA (n = 18). 'Asthma only' controls (no bronchiectasis) and 'bronchiectasis controls' exhibited 91.4% and 81.7% specificity, respectively. Comparison of Aspergillus ICT result with Aspergillus-specific IgG and IgE titres showed no evident immunoglobulin isotype bias. Digital measurements displayed no correlation between ImmunoCAP Aspergillus-specific IgE level and ICT test line intensity. The Aspergillus ICT assay exhibits good sensitivity for ABPA serological screening. It is easy to perform and interpret, using minimal equipment and resources; and provides a valuable simple screening resource to rapidly distinguish more serious respiratory conditions from Aspergillus sensitization alone.

Successful Treatment of Allergic Bronchopulmonary Aspergillosis Using a Combination of Inhaled Fluticasone Furoate/Vilanterol and Oral Voriconazole

Systemic corticosteroids are considered to be the standard treatment for allergic bronchopulmonary aspergillosis (ABPA). However, there is controversy regarding use of inhaled corticosteroid (ICS) therapy for ABPA. Here we report a case of ABPA that was successfully treated with inhaled fluticasone furoate/vilanterol (FF/VI) and oral voriconazole (VRCZ). The patient was a 62-year-old Japanese man with bronchiectasis and diabetes mellitus who presented with fever, cough, and purulent sputum. Computed tomography scans of the chest showed consolidation in the left upper and lower lobes. Laboratory investigations revealed an abnormal increase in the number of eosinophils (3,340/mm 3 ) and elevated levels of C-reactive protein (3.04 mg/dL) and serum immunoglobulin E (IgE) (763 U/mL). Eight days after admission, he experienced a sudden attack of asthma. Aspergillus -precipitating antibodies were positive and Aspergillus fumigatus was detected in sputum culture. These results were consistent with a diagnosis of ABPA, and he was started on inhaled FF/VI and oral VRCZ. Systemic corticosteroids were not used because of the patient’s history of diabetes mellitus and left atrial thrombus. His symptoms and consolidation improved significantly after treatment. He has not experienced an exacerbation for more than 3 years. In mild cases of ABPA in which total IgE is relatively low, inhaled FF/VI in combination with oral VRCZ can be considered as an alternative treatment to systemic corticosteroids in patients with ABPA. J Med Cases. 2020;11(11):348-351 doi: https://doi.org/10.14740/jmc3567

Mepolizumab as Possible Treatment for Allergic Bronchopulmonary Aspergillosis: A Review of Eight Cases

Allergic bronchopulmonary aspergillosis (ABPA) is an eosinophilic pulmonary disorder caused by a hypersensitivity reaction to Aspergillus fumigatus that manifests with uncontrolled asthma, peripheral blood eosinophilia, and radiological findings, such as mucus plugging. Early diagnosis and proper treatment of ABPA are essential to prevent irreversible lung damage such as pulmonary fibrosis and bronchiectasis and improve the quality of life of patients. Beside inhaled medication for asthma, anti-inflammatory agents (i.e., systemic glucocorticoids) and antifungal agents are the mainstay treatment of ABPA. The goal of therapy using glucocorticoids and antifungal agents is to suppress the immune hyperreactivity to A. fumigatus and attenuate the fungal burden. Since the systemic glucocorticoid therapy may lead to serious adverse effects including osteoporosis, avascular necrosis, myopathy, cushingoid appearance, hypertension, insomnia, and increased risk of infection, a glucocorticoid-sparing agent could be considered. Mepolizumab is a humanized monoclonal antibody that binds to interleukin-5, which is the key mediator for eosinophil differentiation, activation, migration, and survival. We review eight cases of ABPA treated successfully with mepolizumab. Treatment with mepolizumab was not restricted to the total immunoglobulin E level, the limiting factor for omalizumab in ABPA. In addition, mepolizumab therapy improved forced expiratory volume in one second, radiological findings, and patient quality of life.

Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory disease caused by immunologic reactions initiated against Aspergillus fumigatus colonizing the airways of patients with asthma and cystic fibrosis. The common manifestations include treatment-resistant asthma, transient and fleeting pulmonary opacities and bronchiectasis. It is believed that globally there are about five million cases of ABPA, with India alone accounting for about 1.4 million cases. The occurrence of ABPA among asthmatic patients in special clinics may be as high as 13 per cent. Thus, a high degree of suspicion for ABPA should be entertained while treating a patient with bronchial asthma, particularly in specialized clinics. Early diagnosis and appropriate treatment can delay (or even prevent) the onset of bronchiectasis, which suggests that all patients of bronchial asthma should be screened for ABPA, especially in chest clinics. The current review summarizes the recent advances in the pathogenesis, diagnosis and management of ABPA.

Allergic bronchopulmonary aspergillosis simulating as lung mass

Allergic bronchopulmonary aspergillosis (ABPA) is a commonly diagnosed entity in patients with a long standing history of asthma. Patients with ABPA can have diverse radiological manifestations. Very rare cases of ABPA, presenting as lung mass have been reported. We hereby report a case of ABPA in whom a large symptomatic lung mass was the presenting manifestation leading to consideration of lung cancer as a differential diagnosis. The establishment of ABPA as the underlying cause lead to conservative medical treatment, which was followed by complete resolution of the mass like opacity.

Estimated Burden of Serious Fungal Infections in Malawi.

Despite efforts to address the burden of fungal infections in Malawi, the prevalence and incidence remain largely unknown. We assessed the annual burden in the general population and among populations at high risk and fungal infection frequencies in each particular population to estimate the national incidence or prevalence. The Malawi population is approximately 17.7 million (2017), with 48% under 15 years of age. Approximately 8% of the population is HIV positive. The most common infections are present in HIV/AIDS patients, with oral candidiasis being the commonest. Life threatening infections among those with AIDS patients include cryptococcal meningitis (8200 cases) and Pneumocystis pneumonia (3690 cases). Pulmonary TB is common, but extra pulmonary TB is rare; an estimated 2329 people have chronic pulmonary aspergillosis after TB. Asthma is a significant problem in Malawi, with an estimated 680,000 adults affected (4.67%) and 14,010 cases of allergic bronchopulmonary aspergillosis (ABPA). Tinea capitis is estimated to be present in over 670,000 young people (21% of school age children). The annual incidence of fungal keratitis is difficult to estimate, but as cases are frequently seen in the eye department, is likely to be a minimum of 1825 (10.3/100,000) cases. Among the most serious infections, cryptococcal meningitis and Pneumocystis pneumonia are top of the list. Overall, some 1,338,523 (7.54%) people are affected by a serious fungal infection in Malawi. These basic estimates are limited, due to poor record keeping, and require epidemiological studies to validate or modify the substantial burden estimates. National surveillance of fungal infections is urgently needed.

A case of allergic bronchopulmonary aspergillosis successfully treated with mepolizumab

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) is an allergic pulmonary disease comprising a complex hypersensitivity reaction to Aspergillus fumigatus. Clinical features of ABPA are wheezing, mucoid impaction, and pulmonary infiltrates. Oral corticosteroids and anti-fungal agents are standard therapy for ABPA, but long-term use of systemic corticosteroids often causes serious side effects.Case presentationA 64-year-old woman was diagnosed with ABPA based on a history of bronchial asthma (from 40 years of age), elevated total IgE, the presence of serum precipitating antibodies and elevated specific IgE antibody to A. fumigatus, and pulmonary infiltration. Bronchoscopy showed eosinophilic mucoid impaction. Systemic corticosteroid therapy was initiated, and her symptoms disappeared. Peripheral eosinophilia and pulmonary infiltration recurred five months after cessation of corticosteroid treatment. Systemic corticosteroids were re-initiated and itraconazole was added as an anti-fungal agent. The patient was free of corticosteroids, aside from treatment with a short course of systemic corticosteroids for asthma exacerbation, and clinically stable with itraconazole and asthma treatments for 3 years. In 2017, she experienced significant deterioration. Laboratory examination revealed marked eosinophilia (3017/μL) and a chest computed tomography (CT) scan demonstrated pulmonary infiltration in the left upper lobe and mucoid impaction in both lower lobes. The patient was treated with high-dose inhaled corticosteroid/long-acting beta-agonist, a long-acting muscarinic antagonist, a leukotriene receptor antagonist, and theophylline; spirometry revealed a forced expiratory volume in 1 s (FEV1) of 1.01 L. An uncontrolled asthma state was indicated by an Asthma Control Test (ACT) score of 18. Mepolizumab, 100 mg every 4 weeks, was initiated for the treatment of severe bronchial asthma with ABPA exacerbation. Bronchial asthma symptoms dramatically improved, and ACT score increased to 24, by 4 weeks after mepolizumab treatment. Peripheral eosinophil count decreased to 174/μL. Spirometry revealed improvement of lung function (FEV1: 1.28 L). A chest CT scan demonstrated the disappearance of pulmonary infiltration and mucoid impaction.ConclusionsTo our knowledge, this is the first case of ABPA to be treated with mepolizumab. Dramatic improvements were observed in symptoms, lung function, peripheral eosinophil counts, and chest images. Mepolizumab could serve as an alternative treatment with the potential to provide a systemic corticosteroid-sparing effect.

A Case of Allergic Bronchopulmonary Aspergillosis with Endobronchial Aspergilloma Diagnosed by Bronchoscopy

A Case of Allergic Bronchopulmonary Aspergillosis with Endobronchial Aspergilloma Diagnosed by Bronchoscopy

A Case of Allergic Bronchopulmonary Aspergillosis Mimicking Primary Lung Cancer

症例は73歳，女性．既往歴で喘息を有していた．検診の胸部X線で右上肺野の異常影を指摘された．胸部CTで左肺S8に最大径40mmの腫瘤と右肺S3に最大径13mmの結節を認めた．PET/CT検査では右肺の病変にFDGの集積なく左肺の病変にFDGの高集積を認めた．2カ月後のCTで左肺の病変のみ増大傾向を認め，原発性肺癌を疑い手術を施行した．術中針生検で癌が疑われ胸腔鏡下左下葉切除術を施行した．病理では拡張した気管支内に多数の好酸球を含む粘液栓子や壊死物質の中に真菌菌糸を認めた．気管支壁には類上皮肉芽腫を認め，アレルギー性気管支肺アスペルギルス症（ABPA）と診断した．ABPAでは，FDG-PET/CT検査でFDGの強い集積を認めることがあり，また，CEAが高値となることがあり，悪性腫瘍との鑑別は困難と考えられた．喘息の既往がある患者ではABPAを念頭に置いた検査の施行を検討すべきと考えられた．