medical decision support medical decision support
Sign In

Criteria for the Diagnosis of Allergic Bronchopulmonary Aspergillosis

Description

Allergic bronchopulmonary aspergillosis (ABPA) occurs in patients with either asthma or cystic fibrosis, with growth of aspergillus hyphae in bronchial mucous. This can result in mucostasis with mucoid plugs, chronic inflammation with bronchial wall injury and bronchiectasis, and/or scarring of distal bronchioles (bronchiolitis obliterans). Symptoms may be minimal to severe, and may be superimposed on those of the underlying lung disease.


 

Symptoms:

(1) none

(2) mild cough

(3) expectoration of thick mucoid plugs

(4) dyspnea

(5) chest pain

(6) wheezing

(7) occasionally hemoptysis (from bronchiectasis or development of fungus balls)

 

Subtypes:

(1) central bronchiectasis (CB): involves central two-thirds of lung fields

(2) seropositive (S): without central (proximal) bronchiectasis

Criteria for Diagnosis

Central Bronchiectasis (minimal criteria)

Seropositive (minimal criteria)

asthma (mild to severe) or cystic fibrosis

x

y

immediate cutaneous reactivity to Aspergillus antigens

x

y

current or previous pulmonary infiltrates

 

y

elevated total serum IgE concentrates (>= 1 mg/L)

x

y

precipitating antibodies to Aspergillus fumigatus

 

 

peripheral blood eosinophilia (at the time of the pulmonary infiltrates, in the absence of oral corticosteroids)

 

 

elevated serum IgE and/or IgG anti-Aspergillus fumigatus (a-Af) antibodies

 

y

proximal bronchiectasis (in the absence of distal bronchiectasis)

x

 

 

where:

• IgE is often reported in IU/mL (conventional) or kIU/L (SIU), where 1 IU = 2.4 ng IgE

 

Differential Diagnosis:

(1) In ABPA there is colonization of the bronchial tree without tissue invasion. With immunosuppression invasive aspergillosis may occur.

(2) Some patients with allergic asthma may have immediate cutaneous reactions to Aspergillus antigens, but those without ABPA will not show the elevated serum anti-Aspergillus antibodies.

 


To read more or access our algorithms and calculators, please log in or register.

Specialty