Allergic bronchopulmonary aspergillosis

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Classification according to ICD-10
B44.1 Other aspergillosis of the lungs
ICD-10 online (WHO version 2019)

The allergic bronchopulmonary aspergillosis ( ABPA ) is a by fungi of the ascomycete - genus Aspergillus triggered mixed-like allergic lung disease (type I and type III allergy ). The allergenic molds include the types Aspergillus fumigatus (often), Aspergillus flavus , Aspergillus niger , Aspergillus terreus and Aspergillus nidulans .

Especially ABPA occurs as a complication of cystic fibrosis on (cystic fibrosis). Here, the ABPA affects at least ten to fifteen percent of patients, preferably from the second decade of life. A distinction must be made between allergic aspergillosis and infectious aspergillosis, which mainly occurs in patients with impaired immune reactions and is associated with a high mortality rate.

Hinson et al. Reported for the first time about allergic bronchopulmonary aspergillosis . in 1952 in England. In the US, Patterson and Golbert diagnosed. the first case in 1968.

Symptoms

The symptoms are usually unclear and rarely allow conclusions to be drawn about the severity of the disease. ABPA is more common in people who already have asthma or cystic fibrosis . Reports of ABPA without these pre-existing conditions are rare. The following symptoms can occur:

  • unexplained weight loss
  • brownish discolored sputum
  • Fever for usually more than three days
  • Chest pain

In terms of symptoms, the disease is easy to confuse with tuberculosis .

Diagnosis

The main criteria of the ABPA are:

  • Bronchial asthma / cystic fibrosis
  • acute / prescribed pulmonary infiltrates
  • Immediate reaction in the skin test to Aspergillus fumigatus
  • increased total IgE in blood serum
  • Antibodies against Aspergillus antigens, as main marker Asp fum and pathognomonic Asp f4 and Asp f6.
  • Blood eosinophils
  • central bronchiectasis
  • specific IgE and specific IgG against Aspergillus fumigatus

Secondary criteria:

  • Evidence of Aspergillus in the sputum
  • Late reaction in the skin test to Aspergillus fumigatus

The diagnostic method of choice remains the x-ray of the lungs and possibly also a high-resolution computed tomography (CT), in which large-scale shading by bronchial secretion congestion (mucoid impactions) can be seen and, as a rule, central bronchiectasis can also be determined.

Stages of the disease

In the literature, the ABPA is divided into five levels. The stages are not to be understood as phases, as a patient can already be in stage five at the initial diagnosis. A reverse development from level III to level II is also possible.

  • Stage I (first manifestation)
  • Stage II (remission - temporary regression of symptoms)
  • Stage III (exacerbation - further deterioration)
  • Stage IV (asthma requiring corticosteroids)
  • Stage V (irreversible fibrotic changes in lung tissue)

therapy

ABPA is currently being treated with a systemic steroid treatment ( cortisone ), possibly supported by an antimycotic ( e.g. itraconazole ). In some cases, it may also be necessary to administer an antibiotic , as the lung infiltrates can be the cause of bacterial pneumonia. A cure is not possible. In particular, care must be taken to avoid the widespread aspergillus, for example by eliminating indoor plants, eliminating feather beds and avoiding domestic animals, especially birds.

Without treatment, scarred areas of the lungs ( fibroses ) develop , which are no longer available for gas exchange. Therefore, therapy must be aimed at preventing stage III-V development.

swell

  1. ↑ KF Hinson, AJ Moon, NS Plummer: Broncho-pulmonary aspergillosis; a review and a report of eight new cases. In: Thorax. 7 (4), Dec 1952, pp. 317-333. PMID 13015523
  2. ↑ R. Patterson, TM Golbert: Hypersensitivity disease of the lung. In: Univ Mich Med Cent J. 34 (1), Jan-Feb 1968, pp. 8-11. PMID 5642343
  3. ↑ S. Hemmann et al.: Skin test reactivity to 2 recombinant Aspergillus fumigatus allergens in A fumigatus-sensitized asthmatic subjects allows diagnostic separation of allergic bronchopulmonary aspergillosis from fungal sensitization. In: J Allergy Clin Immunol. 104 (3 Pt 1), Sep 1999, pp. 601-607.

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