Objective: To investigate the clinical characteristics of Aspergillus fumigatus(A.f)-sensitized asthma and allergic bronchopulmonary aspergillosis (ABPA), which provides a foundation for the diagnosis and differential diagnosis of A.f-sensitized asthma and ABPA, as well as the prevention of ABPA. Methods: This was a single-center retrospective case-control study. Collected the clinical data of patients who visited the Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University from December 2018 to May 2022.A total of 122 patients were included, including 64 males (52.5%) and 58 females (47.5%).The age range was 3 to 89 years.The median age was 44 years.The average age was 41.8 years.The patients were divided into three groups (48 ABPA, 35 A.f-sensitized asthma and 39 HDM-sensitized asthma).Analyzed the differences and correlations among clinical indicators in the three groups, and evaluated the risk factors for the development of ABPA in A.f-sensitized asthma.For statistical analysis, metrological data was tested by t-test or Wilcoxon Mann-Whitney. Classification variables by chi-square test or Fisher's exact test. Pearson correlation analysis for normal distribution data.Spearman correlation analysis for skewed distribution data. Influencing factor analysis was performed using multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was made, the area under the ROC curve (AUC) was calculated, and the sensitivity and specificity of the model were evaluated. Results: Compared with patients with A.f-sensitized asthma, the fractional exhaled nitric oxide (FeNO) [75.00(52.00, 87.00)ppb vs. 40.00(32.00, 52.00)ppb], eosinophils% (EO%) [10.60(6.75, 13.05) vs. 4.10(1.20, 7.30)], eosinophils (EO) [1.50(1.07, 2.20)×10⁹/L vs. 0.33(0.10, 0.54)×10⁹/L], A.f-specific Immunoglobulin E (sIgE) [10.24(4.09, 22.88)KU/L vs. 1.13(0.53, 3.72) KU/L], and sIgE to total IgE(tIgE) ratio (sIgE/tIgE) [0.0049(0.0027, 0.0100) vs. 0.0008(0.0004, 0.0017)] were higher in ABPA patients, the differences were statistically significant (P<0.001). In all patients, tIgE was positively correlated with EO% (r=0.206, P<0.05) and EO (r=0.302, P<0.001). sIgE/tIgE was negatively correlated with one-second rate (FEV1/FVC%) (r=-0.256, P<0.01). The percentage of predicted forced vital capacity [FVC(%)] was negatively correlated with FeNO (r=-0.184, P<0.05).In the ABPA group, the percentage of predicted peak expiratory flow [PEF(%)] was negatively correlated with FeNO (r=-0.295, P<0.05). In the HDM-sensitized asthma group, FeNO was positively correlated with EO% (r=0.49, P<0.01) and EO (r=0.548, P<0.001).The results of logistic regression analysis showed that FeNO and EO were the influencing factors for the development of ABPA in A.f-sensitized asthma. ROC curve analysis results showed that A.f-sIgE (cut-off, 4.108; AUC=0.749;95%CI, 0.632-0.867), sIgE/tIgE(cut-off, 0.0026;AUC=0.749;95%CI, 0.631-0.868), FeNO(cut-off, 55.5;AUC=0.794; 95%CI, 0.687-0.900), EO% (cut-off, 8.70;AUC=0.806;95%CI, 0.709-0.903) and EO (cut-off, 0.815;AUC=0.865;95%CI, 0.779-0.950) had differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO, EO and EO% had good diagnostic efficiency in differentiating A.f-sensitized asthma from ABPA, with a sensitivity of 91.4% and a specificity of 84.4%. Conclusion: Compared with patients with A.f-sensitized asthma, patients with ABPA have more severe eosinophil inflammation. The higher the FeNO and EO, the more likely A.f-sensitized asthma will develop into ABPA.sIgE/tIgE may have differential diagnostic value in A.f-sensitized asthma and ABPA.The combination of FeNO, EO and EO% has good diagnostic efficacy in differentiating A.f-sensitized asthma from ABPA.
Male ; Female ; Humans ; Adult ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Aspergillus fumigatus ; Retrospective Studies ; Case-Control Studies ; Aspergillosis, Allergic Bronchopulmonary/diagnosis* ; Asthma/diagnosis* ; Immunoglobulin E ; Nitric Oxide

Aspergillosis, Allergic Bronchopulmonary ; complications ; diagnosis ; Humans

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) in children with asthma, not associated with cystic fibrosis, is yet to receive the recognition it deserves. OBJECTIVE: To highlight the presentation of ABPA in children with asthma. METHODS: This retrospective review documents the occurrence of pediatric ABPA over a period of 31 years in one unit. Children with asthma, eosinophilia and infiltrates on chest radiograph were screened for ABPA. In these patients, demonstration of immediate hypersensitivity response against Aspergillus species along with serological profile and pulmonary function testing were done. Bronchography/computed tomography (CT) of the chest demonstrated central bronchiectasis (CB). CT of the paranasal sinuses was done in patients with upper airways symptoms. In those suspected with allergic Aspergillus sinusitis (AAS) consent was sought from the parents for the invasive procedure needed for the diagnosis of AAS. RESULTS: Of the 349 patients with ABPA diagnosed, 42 (12.03%) were in the pediatric age group. The mean age on presentation was 12.9 ± 4 years with a male preponderance. All patients had asthma and positive intradermal/skin prick test against Aspergillus species. Ring shadows, the most common radiological presentation, were seen in 28 of 42 patients. Bronchography/CT of the chest demonstrated CB, a feature pathognomic of ABPA, in 32 of 42 patients. High attenuation mucus plugs was observed in 7 of 36 patients while ABPA-seropositive was diagnosed in 10 of 42 patients. On imaging, sinusitis was seen in 20 of 30 patients with upper airways symptoms of whom eight had suspected AAS. Three parents consented for surgery, which confirmed the diagnosis. CONCLUSION: This study highlights the need to evaluate asthmatic children for ABPA as also to exclude AAS.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Bronchiectasis ; Child ; Cystic Fibrosis ; Diagnosis ; Eosinophilia ; Humans ; Hypersensitivity, Immediate ; Male ; Mucus ; Paranasal Sinuses ; Parents ; Radiography, Thoracic ; Respiratory Function Tests ; Retrospective Studies ; Sinusitis ; Thorax

In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagnosis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in patients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hallmark of AAS. In spite of similar histopathologic features, co-existence of ABPA and AAS is still uncommon. Oral corticosteroids continue to be the mainstay of management of allergic aspergillosis. Antifungal agents play an adjunctive role in ABPA as they help reduce the fungal load. Saprophytic colonization in cavitary ABPA may lead to aspergilloma formation, which could increase the severity of the disease. The presence of ABPA, AAS, and aspergilloma in the same patient has also been documented. All patients with Aspergillus-sensitized asthma must be screened for ABPA, and AAS should always be looked for.
Adrenal Cortex Hormones ; Antifungal Agents ; Aspergillosis ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus ; Asthma ; Bronchi ; Bronchiectasis ; Colon ; Cystic Fibrosis ; Diagnosis ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Inhalation ; Paranasal Sinuses ; Respiratory System ; Sinusitis ; Spores ; Sputum

Allergic bronchopulmonary aspergillosis is one of major pulmonary fungal diseases. Although it is not a rare in clinical settings,the misdiagnosis rate is high and the treatment effectiveness remains unstable. This article reviews the recent advances in the diagnosis and treatment of this disease.
Aspergillosis, Allergic Bronchopulmonary ; diagnosis ; therapy ; Humans ; Treatment Outcome

Allergic bronchopulmonary aspergillosis (ABPA) is infrequently documented in children with asthma. Although collapse is not uncommon, middle lobe syndrome (MLS) as a presentation of ABPA is rather a rarity. A 9-year-old female child with asthma presented with increase in intensity of symptoms along with a right midzone patchy consolidation on a chest radiograph. In addition, an ill-defined opacity abutting the right cardiac border with loss of cardiac silhouette was noted. A right lateral view confirmed a MLS, which was further corroborated by high resolution computed tomography. Central bronchiectasis was also observed, which prompted a work-up for ABPA. The child met 7/8 major diagnostic criteria for ABPA. She was then initiated on oral prednisolone that resulted in a marked clinical improvement within a fortnight. Radiological clearance occurred at 3 months with inflation of the middle lobe. ABPA presenting with MLS in a child is yet to be reported. A high index of suspicion is required to establish the diagnosis of ABPA in a child presenting with MLS. This would obviate the invasive investigations usually done to ascertain the cause of MLS.
Aspergillosis, Allergic Bronchopulmonary ; Asthma ; Bronchiectasis ; Child ; Diagnosis ; Female ; Humans ; Inflation, Economic ; Middle Lobe Syndrome ; Prednisolone ; Radiography, Thoracic

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease with small prevalence. Exposure to aspergillus mold causes immunologic hypersensitivity and may cause ranges of symptoms from minimal to detrimental outcomes. Diagnosing and treating the disease before the development of bronchiectasis may save the patient from poor outcomes. This report presents a case of recurrent ABPA without any symptom of asthma, which impeded the correct diagnosis even after numerous hospitalizations.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Bronchiectasis ; Delayed Diagnosis ; Diagnosis ; Fungi ; Hospitalization ; Humans ; Hypersensitivity ; Lung Diseases ; Prevalence

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder induced by Aspergillus fumigatus that occurs generally in patients with underlying chronic airway disorders. However, the development of ABPA associated with lung malignancy remains unknown. An 80-year-old woman was admitted for evaluation of chronic cough. Her radiologic finding was a mass like opacity with mucoid impaction, showing finger-in-glove sign, one of the typical radiologic findings for ABPA. In addition, laboratory tests revealed that her data satisfied the diagnostic criteria for ABPA. Interestingly, final pathologic examination showed that the mass lesion was small cell lung cancer. Here, we describe a case of delayed diagnosis of small cell lung cancer with ABPA, suggesting that a possibility of accompanying lung malignancy such as small cell lung cancer should be considered in patients with ABPA. This case let us realize the importance of clinical suspicion that different entities of diseases can be occurred simultaneously for the correct diagnosis without delay.
Aged, 80 and over ; Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus fumigatus ; Cough ; Delayed Diagnosis* ; Diagnosis ; Female ; Humans ; Hypersensitivity ; Linear Energy Transfer ; Lung ; Small Cell Lung Carcinoma*

A 55-year-old woman was referred to the division of pulmonology at Severance Hospital for the investigation of uncontrolled asthma with recurrent cough at night, blood-tinged sputum, malaise, and wheezing since 3 months. Chest computed tomography revealed bronchiectasis and broncholithiasis in the lateral segmental bronchus of the right middle lobe and the anterobasal segmental bronchus of the right lower lobe. Bronchoscopic broncholith removal was performed because of recurrent blood-tinged sputum and the outflow of purulent exudate behind the broncholith in the lateral segmental bronchus of the right middle lobe. The extracted material presenting amorphous eosinophilic necrotic materials with calcification was compatible with broncholithiasis. Following decalcification, histopathology revealed degenerated septate fungal hyphae and spores that were morphologically consistent with Aspergillus spp. A final diagnosis was allergic bronchopulmonary aspergillosis (ABPA) forming broncholith. The results from this case suggest that the early recognition of ABPA should be considered in patients with uncontrolled asthma accompanied by broncholithiasis.
Aspergillosis, Allergic Bronchopulmonary* ; Aspergillus ; Asthma* ; Bronchi ; Bronchiectasis ; Cough ; Diagnosis ; Eosinophils ; Exudates and Transudates ; Female ; Humans ; Hyphae ; Middle Aged ; Pulmonary Medicine ; Respiratory Sounds ; Spores ; Sputum ; Thorax

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