Case Of Allergic Bronchopulmonary Aspergillosis Research Articles

TWO CASES OF ALLERGIC BRONCHOPULMONARY MYCOSIS

We present two cases of allergic bronchopulmonary aspergillosis or allergic bronchopulmonary penicilliosis. The first cas was a 15 year-old male with bronchial asthma. Chest roentgenogram showed an infiltration shadow in the bilateral upper lung fields, predominantly in the right upper lobe. Total serum IgE was 39000U/ml, RAST score to Aspergillus was 3, and peripheral blood eosinophil counts were 4984/μl. Type I skin reaction against Aspergillus was positive. Bronchoscopy showed mucoid impaction and Aspergillus grew in sputum cultures. Precipitating antibodies to Aspergillus were positive (16×) After corticosteroid administration, the symtoms and abnormal findings of chest roentgenogram were improved remarkably.The second case was all year-old male, who also had bronchial asthma. The chest roentgenogram showed total atelectasis of right lung field and mediastinum deviated towards the right. Total serum IgE was 975U/ml, RAST score to Penicillium was 2 and peripheral blood eosinophil counts were 584/μl. The type I skin reaction against Penicillium was positive. Bronchoscopy showed mucoid impaction, accompanied with positive fungus culture for Penicillium species. After corticosteroid administration, those symptoms and abnormal findings of chest roentgenogram were improved for a short while.

A case of allergic bronchopulmonary aspergillosis successfully treated with itraconazole

Oral corticosteroid treatment of allergic bronchopulmonary aspergillosis (ABPA) prevents the bronchial environment from being hospitable to Aspergillus by inhibiting harmful immunologic reactions. Despite these benefits of corticosteroids, it is widely known that they have long-term side-effects. Itraconazole is a new oral triazole antifungal agent with low toxicity that is active against Aspevgillus spp. in vitro as well as in vivo (1). The present authors administered itraconazole monotherapy in a young woman with ABPA. The symptoms, signs, partial atelectasis and laboratory findings improved after 6 weeks. Although she experienced two mild relapses, the symptoms subsided without corticosteroid therapy. She has been taking itraconazole for 20 months, and no adverse effects have been observed.

Purification of a major allergen, Asp f 2 binding to IgE in allergic bronchopulmonary aspergillosis, from culture filtrate of Aspergillus fumigatus

Most cases of allergic bronchopulmonary aspergillosis (ABPA) are caused by the fungus Aspergillus fumigatus. Successful treatment of this disease depends on early diagnosis with the use of well-characterized and relevant antigens/allergens of the organism. The aim of this study was to purify and characterize relevant proteins from A. fumigatus that could be used in the reliable diagnosis of ABPA. Monoclonal antibodies were raised against A. fumigatus culture filtrate antigens. A Concanavalin A nonbinding protein fraction was purified with use of one of the monoclonal antibody immunoaffinity columns. The purified protein was analyzed on sodium dodecylsulfate-polyacrylamide gel electrophoresis gel and Western blots. The sensitivity and specificity of the purified protein were evaluated by RAST and ELISA with sera from 25 patients with ABPA, from 10 with allergic asthma, and from 10 normal control subjects. The 37 kD Concanavalin A nonbinding protein reacted specifically with IgE antibodies in patients with ABPA. Among the 25 patients with ABPA studied, 96% had IgE antibody against the allergen, whereas none of the subjects with allergic asthma who had positive results on the skin prick test or normal control subjects had a reaction. Both RAST and ELISA results exhibited strong correlation with IgE binding. This allergen exhibited N-terminal sequence identity to a recombinant allergen Asp f 2. A 37 kD protein with complete N-terminal homology to Asp f 2 is a major allergen of A. fumigatus that significantly reacts with IgE antibody in patients with ABPA, but does not elicit reaction in Aspergillus-sensitive subjects with asthma and normal control subjects.

Allergic bronchopulmonary aspergillosis in lung allograft recipients

Following lung transplantation for end-stage cystic fibrosis, two male patients presented with shortness of breath, peripheral blood eosinophilia and segmental lung collapse. At bronchoscopy, each had bronchial mucous plugging containing Aspergillus fumigatus. This finding was associated with a systemic eosinophilia and skin test positivity to Aspergillus. Augmented steroid therapy resulted in the successful resolution of the symptoms. We believe that these are the first reported cases of allergic bronchopulmonary aspergillosis in lung allograft recipients.

A case of allergic bronchopulmonary aspergillosis complicated with eosinophilic heart disease

A case of allergic bronchopulmonary aspergillosis complicated with eosinophilic heart disease

Concomitant allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis with an operated aspergilloma

The three clinical categories of Aspergillus-related respiratory disorders, allergic bronchopulmonary aspergillosis (ABPA), allergic Aspergillus sinusitis (AAS), and aspergilloma usually remain mutually exclusive. Coexistent ABPA with aspergilloma, though infrequent, has been reported,’ whereas concomitant occurrence of ABPA and AAS is a rarity.’ Furthermore, AJ3PA presenting as a collapsed lung with associated pleural effusion has been documented only once before.3 We describe a case of ABPA with concomitant AAS in a patient who had earlier undergone a lobectomy for severe hemoptysis as a result of an aspergilloma in a bronchiectatic cavity. The patient presented to us with collapse of the left lung

経気管支的 Fluconazole 注入が有効であったアレルギー性気管支肺アスペルギルス症の 1 例

経気管支的 Fluconazole 注入が有効であったアレルギー性気管支肺アスペルギルス症の 1 例

Cytology of allergic bronchopulmonary aspergillosis

The cytologic features of a case of allergic bronchopulmonary aspergillosis (ABPA) are reported and the literature reviewed. The bronchial brushing smears in this case showed mucus that contained laminated aggregates of eosinophils with scattered Charcot-Leyden crystals and fungal hyphae. These cytologic findings, overlooked by the initial examining pathologist, reflected the "mucoid impaction of bronchi" component of ABPA and are therefore diagnostic of ABPA. A cytologic diagnosis of a clinically unsuspected ABPA would lead to the correct treatment and prevent unnecessary surgery.

Circulating complement (C3),C3c and immune complexes in ABPA patients

Complement (C3), its split product (C3c), CRP and circulating immune complexes were studied in 10 patients with allergic bronchopulmonary aspergillosis (ABPA) and compared with 10 age and sex matched controls. An insignificant decrease and significant increase in the levels of C3 and C3c, respectively, was observed in ABPA patients in comparison with controls. The CRP was found to be present only in those cases who showed increased levels of C3. The circulating immune complexes were detected in 90% of ABPA cases. The role of complement and circulating immune complexes is discussed.

Pathologic features of allergic bronchopulmonary aspergillosis.

We describe the pathologic features in surgically excised lung tissue specimens from 18 cases of allergic bronchopulmonary aspergillosis (ABPA). The main abnormalities involved bronchi and bronchioles. All cases showed bronchocentric granulomatosis (BCG), mucoid impaction of bronchi (MIB), or both. The impacted mucin of MIB contained large numbers of eosinophils and Charcot-Leyden crystals. A distinctive exudative bronchiolitis was present distal to areas of BCG in 13 cases. This lesion was characterized by filling of bronchiolar lumens with necrotic neutrophils and eosinophils in a basophilic mucinous exudate. A peribronchiolar chronic inflammatory infiltrate was seen in 15 cases; eosinophils were prominent in 10 of these cases. Foci of eosinophilic pneumonia were seen in 13 cases, and noninvasive fungal hyphae were identified in 14. We conclude that the finding of BCG or MIB, or a combination of both, especially in conjunction with tissue eosinophilia, should suggest the diagnosis of ABPA. When noninvasive fungal hyphae are also present, the changes are diagnostic of ABPA or a related allergic fungal reaction.

Prolonged evaluation of patients with corticosteroid-dependent asthma stage of allergic bronchopulmonary aspergillosis

Eight cases with stage IV allergic bronchopulmonary aspergillosis (ABPA) (corticosteroid-dependent asthma stage) were observed for a total of 82 patient years with individual patients observed for 7 to 19 years (mean 10.2) years. One case is the first case of ABPA diagnosed in the United States in 1967. A second case has been observed through four stages of ABPA. None of these eight cases has demonstrated pulmonary deterioration by clinical, chest roentgenogram, or pulmonary function analysis. After diagnosis, the maintenance dose of prednisone in seven of eight cases was a low to moderate dose alternate-day prednisone. These results suggest that continuous observation and management of episodes of pulmonary consolidation or asthma exacerbations may prevent the progression of ABPA to stage V (fibrotic end stage). The total IgE may remain elevated in these patients, and therapy should not attempt to reduce total serum IgE to normal levels. After prolonged therapy with prednisone for asthma and control of ABPA, the IgE and IgG antibody indices against Aspergillus fumigatus may remain elevated or may be below the levels that are of diagnostic value.

A Review of Mycoses Caused by Unusual Fungi

Infections caused by fungi formerly thought to be non-pathogenic or of very low pathogenicity are on the increase. Members of the genera Fusarium, Bipolaris (Drechslera), Botryodiplodia and Glomerella are common soil saprophytes and plant pathogens known to occasionally cause mycotic keratitis in Japan.Paecilomyces lilacinus, a well-known soil saprophyte is seldom pathogenic to human. Only 3 cases of ocular mycosis caused by P. lilacinus have been reported in Japan but the disease has also been found in other areas of the world including the United States and Australia after intraocular lens implantation. Five cases of cutaneous mycoses caused by P. lilacinus have been reported in compromised hosts such as those taking immunosuppresive drugs or those with an immune deficiency.Only about 6 cases of allergic bronchopulmonary aspergillosis caused by Aspergillus oryzae (koji-mold) have been reported. This infection is caused by the environmentally ubiquitous koji-mold that is used as a fermentation starter by brewers of soy sauce, soybean paste and Sake. All 6 patients are family members of fermented food manufactures. Strains of A. oryzae were cultured from the patient sputa or bronchial alveolar lavage.

Allergic bronchopulmonary aspergillosis and sensitization to Aspergillus fumigatus in chronic bronchiectasis in adults.

Fifty adult subjects for whom a diagnosis of idiopathic bronchiectasis (excluding those secondary to tuberculosis or hypogammaglobulinaemia) had been confirmed previously were investigated by: questionnaire; blood eosinophil count; sputum culture for Aspergillus fumigatus and eosinophil count; chest radiography; skin-prick tests with several aeroallergens and four preparations of A. fumigatus, including a reference extract; measurement of specific IgE antibodies; precipitin testing and self-crossed immunoelectrophoresis with A. fumigatus. Five subjects were possible cases of allergic bronchopulmonary aspergillosis in whom the condition had been previously misdiagnosed or in whom sensitization to A. fumigatus had occurred after the onset of bronchiectasis. These five subjects had positive immediate skin reactions to A. fumigatus and a history of recurrent pneumonias. Four had a previous history of asthma and the others showed increased bronchial responsiveness to inhaled methacholine. At the time of the survey, A. fumigatus grew in the sputum of one out of five subjects. These subjects had increased levels of specific IgE. Two had precipitins by double diffusion and three subjects were positive on self-crossed immunoelectrophoresis. It is concluded that allergic bronchopulmonary aspergillosis or evidence of sensitization to A. fumigatus can be identified in a significant proportion of adult subjects with so-called idiopathic bronchiectasis.

Development of allergic bronchopulmonary aspergillosis during treatment of severe asthma with systemic corticosteroids

Rapid clinical improvement of allergic bronchopulmonary aspergillosis (ABPA) is usually noted with corticosteroid therapy. We report a case of ABPA that developed in a patient who was being treated with prednisone on a maintenance basis for severe asthma. Recovery from the short-term episode of ABPA was protracted and required higher doses of corticosteroids for control of the syndrome than usually necessary. It is suggested that corticosteroids do not prevent the development of ABPA, and that patients who develop the syndrome while on corticosteroids may have a protracted course with poor response to the usually effective doses of corticosteroids.

Efficacy of Counterimmunoelectrophoresis in the Detection of Fungal Antibodies in Allergic Bronchopulmonary Mycoses1

The allergic bronchopulmonary mycoses (ABPM) are characterized by dual antibody response which includes immediate Type I and delayed Type III Arthus reactions to fungal antigens. In such cases the demonstration of precipitins is of diagnostic importance. In the present study the efficacy of counterimmunoelectrophoresis (CIE) has been compared with that of conventional agar gel double immunodiffusion technique (DID). Cases of allergic bronchopulmonary aspergillosis (ABPA) and candidiasis (ABPC) were diagnosed in a survey among patients with pulmonary diseases on the basis of positive clinical, radiological, mycological and immunological findings. Precipitating fungal antibodies were detected by CIE and DID techniques in 77 and 59 cases of ABPA and ABPC respectively. The former technique revealed double or multiple bands as against a single band observed in double immunodiffusion in a great majority of these cases. With CIE it was further possible to demonstrate the presence of precipitins in about 65 per cent of suspected cases of ABPM found otherwise negative in DID tests. The CIE has proved to be a more efficacious serodiagnostic procedure in allergic bronchopulmonary mycoses in which antibody levels are known to vary a great deal.

Allergic bronchopulmonary aspergillosis and bilateral fungal balls terminating in disseminated aspergillosis

A unique case of allergic bronchopulmonary aspergillosis associated with bilateral apical aspergillomas terminating in disseminated aspergillosis is presented. Postulated mechanisms of this combination are discussed with respect to the patient's clinical findings. The contribution of systemic and aerosolized corticosteroids are considered major contributing factors to dissemination of disease.

Allergic bronchopulmonary aspergillosis in pediatric practice

Twelve cases of allergic bronchopulmonary aspergillosis in the pediatric age group are reported. The average age of diagnosis was 14.5 years with a range from 6 to 18 years. All patients had a history of pulmonary infiltrations or atelectasis or both documented by chest radiographs. Eight patients had bronchograms or tomograms, and seven of them showed proximal bronchiectasis. Total serum IgE concentrations were elevated in all patients. Preciptitating antibodies against Aspergillus fumigatus were positive in all patients at the time of diagnosis, and became negative in some after therapy. The specific IgE or IgG antibody activity agaist Af was elevated in all 12 patients. After prednisone was started the total serum IgE sharply declined to a plateau and remained at this level until a flare of allergic aspergillosis occurred. A flare of allergic aspergillosis is characterized by an increasing total serum IgE concentration followed by pulmonary infiltration. Clinical and roentgenologic improvements were observed after steroid therapy. The importance and methods of early diagnosis in the pediatric population are discussed.

Allergic Bronchopulmonary Aspergillosis with Obstruction of the Upper Respiratory Tract

A case of allergic bronchopulmonary aspergillosis is presented. The only symptoms in this 24-year-old woman patient were those of recurrent nasal obstruction, including mucosal ulcerations, edema, and thick secretions within the nose.

PIE (pulmonary infiltration with eosinophilia) syndrome--a case of allergic bronchopulmonary aspergillosis

PIE (pulmonary infiltration with eosinophilia) syndrome--a case of allergic bronchopulmonary aspergillosis