Diagnosis of Allergic Bronchopulmonary Aspergillosis: A Case-Based Approach

Sahajal Dhooria; Ritesh Agarwal

Disclosures

Future Microbiol. 2014;9(10):1195-1208. 

In This Article

Abstract and Introduction

Abstract

Allergic bronchopulmonary aspergillosis is a pulmonary disease occurring in patients with asthma or cystic fibrosis, consequent to a dysregulated immune response to inhaled Aspergillus conidia. The usual presentation is with poorly controlled asthma. Patients may also present with expectoration of mucus plugs, hemoptysis, constitutional symptoms and radiological opacities. Patients may experience smoldering lung destruction despite well-controlled asthma. With emerging data, the diagnostic criteria transcribed by an International Expert Committee in 2013 are the latest evidence-based guidelines. Herein, we utilize a case-based approach to elaborate on the diagnosis of this disease. The review intends to provide a lucid understanding of the diagnostic process for the expert as well as the primary physician, involved in management of this enigmatic disorder.

Introduction

Allergic bronchopulmonary aspergillosis (ABPA) is a respiratory disorder consequent to a perturbed immune response to inhaled Aspergillus fumigatus conidia, occurring in patients with bronchial asthma or cystic fibrosis (CF).[1] The disease is associated with considerable morbidity resulting in worsening of the underlying disease and may result in smoldering lung destruction.[2] Diagnosis is easy in a patient presenting with classical clinical manifestations and characteristic laboratory test results.[3] In others, it may be perplexing. The diagnostic criteria for ABPA have been revised several times over the past six decades since the malady was first brought to attention.[4–7] But the diagnostic process is far from perfect, primarily because of the lack of a gold standard. The recommendations proposed by an International Working Group of ABPA complicating asthma (formed by the International Society for Human and Animal Mycology) in 2013 are the latest evidence-based guideline on the diagnosis, staging and management of this disease.[7] The article focuses on the diagnosis of ABPA complicating bronchial asthma using a case-based approach. Five case scenarios from our chest clinic are discussed in the article (Box 1), which are representative of the various entities related to ABPA. Using these representative cases, the major clinical manifestations and laboratory features of ABPA are explained in detail to highlight the peculiarities of this perplexing condition. The article then delves into a logical approach towards diagnosis of ABPA utilizing a combination of several laboratory investigations to arrive at the diagnosis.

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