Aspergillus is a ubiquitous fungus which is found in soil, composed piles, and even in the air. It causes various clinical syndromes, which are mainly determined by the immunocompetence of host; simple colonization in normal person, aspergilloma in patients with lung cavities (e.g. after tuberculosis), chronic necrotizing pneumonia in mildly immunocompromised hosts (e.g. DM or alcoholics) or those who have chronic lung diseases, invasive aspergillosis which is severe and commonly fatal in immunocompromised patients. It may cause hypersensitivity reaction; IgE-mediated asthma, hypersensitivity pneumonitis (extrinsic allergic alveolitis), allergic Aspergillus sinusitis, allergic bronchopulmonary aspergillosis (ABPA). It is essential for clinicians to be familiar with the spectrum of Aspergillus-related clinical syndromes. After a brief review of each clinical syndrome, ABPA that is a typical allergic disease was reviewed in detail.
Alveolitis, Extrinsic Allergic ; Aspergillosis ; Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Colon ; Fungi ; Humans ; Hypersensitivity ; Immunocompetence ; Immunocompromised Host ; Lung ; Lung Diseases ; Pneumonia ; Pulmonary Aspergillosis* ; Sinusitis ; Soil

The first case of allergic bronchopulmonary aspergillosis(ABPA) was reported by Hinson, et al. in 1952. This was followed by a number of significant description of the disorder. Although typical ABPA initially presents with asthma, fleeting pulmonary infiltrates, and marked eosinophilia, there are many other ways in which the disease may be first manifested. Common radiologic findings in ABPA include pulmonary infiltrates, atelectasis, emphysema, fibrosis, lobar shrinkage with hilar elevation, cavitation, pneumothorax, aspergilloma and central bronchiectasis. We experienced a case of allergic bronchopulmonary aspergillosis presenting rare radiologic finding of bilateral pulmonary masses in chest radiography. With oral corticosteroid treatment, the size of both pulmonary masses was decreased significantly and his asthmatic symptoms were improved.
Aspergillosis, Allergic Bronchopulmonary* ; Asthma ; Bronchiectasis ; Emphysema ; Eosinophilia ; Fibrosis ; Pneumothorax ; Pulmonary Atelectasis ; Radiography ; Thorax

Humans ; Laryngopharyngeal Reflux ; Sleep Apnea, Obstructive

OBJECTIVETo understand the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA) so as to diagnose and treat the disease earlier.

METHODA retrospective study was conducted on ABPA patients diagnosed in the Second Department of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University from April 2010 to March 2014. The literature of children's ABPA retrieved from the databases at home and abroad in recent 10 years were analyzed.

RESULT(1) Among the 4 cases of ABPA, cystic fibrosis (CF) and asthma were diagnosed in 2 and 1 cases, respectively. Cough was present in 3 patients, recurrent wheezing in 2 and chest tightness in 1 case. CT scans showed central bronchiectasis in all 4 cases, while 1 patient had migratory shadows. All cases had elevated serum total IgE, immediate cutaneous reaction to aspergillus fumigatus; A. fumigatus-specific IgE and IgG were positive in 4 cases. The diagnosis of the 4 cases was confirmed according to the history, radiologic investigations and laboratory findings. All of them were improved after the treatment with glucocorticosteroid and antifungal agents (voriconazole or itraconazole). (2) We retrieved articles on the ABPA in the databases at home and abroad published in the recent 10 years, there were 22 foreign reports and only one case in domestic report. Among the 22 foreign cases, 16 patients were CF, 3 were asthmatics. ABPA was diagnosed as the initial presentation in only one case with CF.

CONCLUSIONIn asthmatics or the patients with allergic disease, if there are highly elevated serum total IgE, central bronchiectasis or recurrent atelectasis in chest imaging, the patients should be further investigated for ABPA. The diagnosed cases of ABPA should be screened for CF routinely.

Antifungal Agents ; Aspergillosis, Allergic Bronchopulmonary ; diagnosis ; therapy ; Aspergillus fumigatus ; Asthma ; Bronchiectasis ; Child ; Cough ; Cystic Fibrosis ; Humans ; Pulmonary Atelectasis ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed ; Voriconazole

No abstract available.
Allergens ; Food Hypersensitivity ; Asthma ; Invasive Pulmonary Aspergillosis ; Aspergillosis, Allergic Bronchopulmonary

PURPOSE: Exercise-induced bronchoconstriction (EIB) is common in “high ventilation” athletes, and the Eucapnic Voluntary Hyperpnea (EVH) airway provocation test is the standard EIB screen. Although the EVH test is widely used, the in-test performance in high ventilation athletes as well as the reproducibility of that performance has not been determined. Reproducibility of pre- and post-test spirometry and self-reported atopy/cough was also examined. METHODS: High ventilation athletes (competitive swimmers; n=11, 5 males) completed an atopy/cough questionnaire and EVH testing (operator controlled FiCO₂) on 2 consecutive days. RESULTS: Swimmers achieved 85%±9% and 87%±9% of target FEV1 volume on days 1 and 2, respectively, (P=0.45; ICC 0.57 [0.00-0.86]) resulting in a total ventilation of 687 vs 684 L [P=0.89, ICC 0.89 (0.65-0.97]) equating to 83%±8% and 84%±9% of predicted total volume (ICC 0.54 [0.00-0.85]) between days 1 and 2. FiCO₂ required to maintain eucapnic conditions was 2.5%. Pre-test FEV1 was less on day 2 (P=0.04; ICC >0.90). Day 1 to 2 post-test FEV1 was not different, and 4 swimmers were EIB positive (>10% fall in pre-post FEV1) on day 1 (3 on day 2). CONCLUSIONS: EVH in-test performance is reproducible however required less FiCO₂ than standard protocol and the swimmers under-ventilated by 125 and 139 L/min for days 1 and 2, respectively. How this affects EIB diagnosis remains to be determined; however, our results indicate a post-test FEV1 fall of ≥20% may be recommended as the most consistent diagnostic criterion.
Asthma, Exercise-Induced ; Athletes* ; Bronchoconstriction ; Cough ; Diagnosis ; Humans ; Respiratory Hypersensitivity ; Spirometry ; Swimming ; Ventilation*

Aspergillosis is a systemic fungal infection caused by Aspergilli, mainly, Aspergillus fumigatus. The pulmonary aspergillosis is a group of three separate disease, comprising invasive aspergillosis, aspergilloma, and allergic bronchopulmonary aspergillosis (ABPA), or a disease process in which one of three entities overlap with another process. ABPA is a chracterized clinically by asthma, blood and sputum eosinophilia and recurrent pulmonary infiltrations or mucoid impaction, which pathogenesis seems to be hypersensitivity reaction to Aspergillus fumigatus (Af). Recently we experienced a case of ABPA, one of three clinical manifestations of pulmonary aspergillosis. He had asthma as an infant, but had no asthmatic symptoms on admission, and there was no evidence of fungal infection at blood culture and routine bacterial culture with sputum. But, diagnosis was confirmed by test for immediate skin reaction to Af was positive, skin prick test and Greenburg and Petterson's criteria. After steroid treatment, he became asymptomatic. We report this case with brief review of literature.
Aspergillosis ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Asthma ; Diagnosis ; Eosinophilia ; Humans ; Hypersensitivity ; Infant ; Pulmonary Aspergillosis ; Skin ; Sputum

No abstract available.
Asthma, Exercise-Induced*

The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or Cystic space. Invasive pulmonary aspergillosis is serious, usually fatal infection in patients being treated with immunosuppressants or who have chronic debilitating disease. Allergic bronchopulmonary aspergillosis is charaterized clinically by asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Awareness of the radio-graphic and CT findings of pulmonary aspergillosis is important in making the diagnosis of aspergillus-caused pulmonary disorders. In this pictorial essay, we illustrated various radiological findings of pulmonary aspergillosis focused on CT findings correlated with gross pathologic specimens.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Colon ; Diagnosis ; Eosinophilia ; Fungi ; Humans ; Immunosuppressive Agents ; Invasive Pulmonary Aspergillosis ; Pulmonary Aspergillosis* ; Sputum

The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or Cystic space. Invasive pulmonary aspergillosis is serious, usually fatal infection in patients being treated with immunosuppressants or who have chronic debilitating disease. Allergic bronchopulmonary aspergillosis is charaterized clinically by asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Awareness of the radio-graphic and CT findings of pulmonary aspergillosis is important in making the diagnosis of aspergillus-caused pulmonary disorders. In this pictorial essay, we illustrated various radiological findings of pulmonary aspergillosis focused on CT findings correlated with gross pathologic specimens.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Colon ; Diagnosis ; Eosinophilia ; Fungi ; Humans ; Immunosuppressive Agents ; Invasive Pulmonary Aspergillosis ; Pulmonary Aspergillosis* ; Sputum