A clinical analysis of 26 cases of allergic bronchopulmonary aspergillosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Mengyu , QIAO Yanjun ,  WANG Hongmin

Department of Respiratory Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China;

Corresponding?author：

WANG Hongmin, Email: hyywang2000@126.com

Keywords：

Allergic bronchopulmonary aspergillosis; Asthma; Diagnosis; Treatment

DOI：

10.7507/1671-6205.201810055

Video：

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Objective To analyse the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA). Methods The clinical data of 26 patients diagnosed as ABPA from September 2016 to February 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results Among 26 patients with ABPA, 15 were female, 11 were male, with a mean age of (47.6±11.7) years. Before the diagnosis of ABPA, 13 cases had been misdiagnosed as bronchial asthma, 8 as bronchiectasis, 8 as pulmonary infection, 3 as tuberculosis. All patients had cough, sputum production, wheeze in 2, fever in 5, hemoptysis in 4, chest pain in 4, dyspnea in 2. The wheezing sound were heard in 20 patients and wet rales were heard in 4 cases. All patients had increased total IgE level ［median 5 000 (654 – 5 337)IU/ml］. The eosinophil counts were increased in 23 patients ［median 0.99 (0.50 – 3.69)×10⁹/L］ and percentages of peripheral blood eosinophil were elevated to (0.36±0.10). Skin prink test was positive in 10 cases. All patients had increased Aspergillus fumigatus specific IgE ［median 15.1 (0.4 – 29.6)kU/L). Chest X-ray showed fleeting consolidation. Chest CT showed multiple pachy, central cylindrical bronchiectasis, mucous plugging, band linear or glover-finger opacities. Sixteen cases underwent bronchoscopy, out of them 5 cases underwent transbronchial lung biopsy, 2 cases underwent CT guided percutaneous lung biopsy. Fourteen cases were treated with oral corticosteroids combined with antifungal therapy. Conclusions ABPA is a relatively rare and without specific clinical manifestations. In the early period, it is mostly misdiagnosed as bronchial asthma, so it is necessary to improve the early diagosis of ABPA and give appropriate treatment. Regular follow-up should be made to prevent the recurrence.

Citation： WANG Mengyu, QIAO Yanjun, WANG Hongmin. A clinical analysis of 26 cases of allergic bronchopulmonary aspergillosis. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(3): 231-235. doi: 10.7507/1671-6205.201810055 Copy

1.	Singh SI, Agarwal R. Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations. Eur Respir Rev, 2014, 23(131): 149-152.
2.	Reddy A, Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract, 2017, 5(3): 866-867.
3.	中華醫學會呼吸病學分會哮喘學組. 變應性支氣管肺曲霉病診治專家共識. 中華醫學雜志, 2017, 97(34): 2650-2656.
4.	Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46(3): 327-360.
5.	任少華, 胡華成. 變態反應性支氣管-肺煙曲菌病的臨床研究進展. 中國呼吸與危重監護雜志, 2003, 2(5): 62-64.
6.	馬艷良, 張為兵, 余兵, 等. 支氣管哮喘患者中變應性支氣管肺曲霉病的檢出及臨床特點初步調查. 中華結核和呼吸雜志, 2011, 34(12): 909-913.
7.	Agarwal R, Aggarwal AN, Gupta D, et al. Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis. Int J Tuberc Lung Dis, 2009, 13(8): 936-944.
8.	Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy, 2013, 43(8): 850-873.
9.	Sunzini F, Barbato C, Canofari C, et al. Clinical and radiological signs of ABPA associated with airways infection with Aspergillus in the absence of specific IgE. Eur Ann Allergy Clin Immunol, 2016, 48(5): 202-204.
10.	Schwartz HJ, Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma, determined by serologic and radiologic criteria in patients at risk. J Lab Clin Med, 1991, 117(2): 138-142.
11.	陸海雯, 衛平, 徐金富. 變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展. 中國呼吸與危重監護雜志, 2014, 13(5): 534-536.
12.	Agarwal R, Khan A, Garg M, et al. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol, 2012, 4(4): 141-150.
13.	Agarwal R. Allergic bronchopulmonary aspergillosis. Chest, 2009, 135(3): 805-826.
14.	Moss RB. Treating allergic bronchopulmonary aspergillosis: the way forward. Eur Respir J, 2016, 47(2): 385-387.
15.	Agarwal R, Aggarwal AN, Dhooria S, et al. A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J, 2016, 47(2): 490-498.
16.	Jat KR, Walia DK, Khairwa A. Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis. Cochrane Database Syst Rev, 2018, 3: D10288.
17.	Leon EE, Craig TJ. Antifungals in the treatment of allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol, 1999, 82(6): 511-516.
18.	Zirbes JM, Milla CE. Steroid-sparing effect of omalizumab for allergic bronchopulmonary aspergillosis and cystic fibrosis. Pediatr Pulmonol, 2008, 43(6): 607-610.
19.	Agarwal R, Gupta D, Aggarwal AN, et al. Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med, 2010, 104(2): 204-210.

1. Singh SI, Agarwal R. Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations. Eur Respir Rev, 2014, 23(131): 149-152.
2. Reddy A, Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract, 2017, 5(3): 866-867.
3. 中華醫學會呼吸病學分會哮喘學組. 變應性支氣管肺曲霉病診治專家共識. 中華醫學雜志, 2017, 97(34): 2650-2656.
4. Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46(3): 327-360.
5. 任少華, 胡華成. 變態反應性支氣管-肺煙曲菌病的臨床研究進展. 中國呼吸與危重監護雜志, 2003, 2(5): 62-64.
6. 馬艷良, 張為兵, 余兵, 等. 支氣管哮喘患者中變應性支氣管肺曲霉病的檢出及臨床特點初步調查. 中華結核和呼吸雜志, 2011, 34(12): 909-913.
7. Agarwal R, Aggarwal AN, Gupta D, et al. Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis. Int J Tuberc Lung Dis, 2009, 13(8): 936-944.
8. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy, 2013, 43(8): 850-873.
9. Sunzini F, Barbato C, Canofari C, et al. Clinical and radiological signs of ABPA associated with airways infection with Aspergillus in the absence of specific IgE. Eur Ann Allergy Clin Immunol, 2016, 48(5): 202-204.
10. Schwartz HJ, Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma, determined by serologic and radiologic criteria in patients at risk. J Lab Clin Med, 1991, 117(2): 138-142.
11. 陸海雯, 衛平, 徐金富. 變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展. 中國呼吸與危重監護雜志, 2014, 13(5): 534-536.
12. Agarwal R, Khan A, Garg M, et al. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol, 2012, 4(4): 141-150.
13. Agarwal R. Allergic bronchopulmonary aspergillosis. Chest, 2009, 135(3): 805-826.
14. Moss RB. Treating allergic bronchopulmonary aspergillosis: the way forward. Eur Respir J, 2016, 47(2): 385-387.
15. Agarwal R, Aggarwal AN, Dhooria S, et al. A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J, 2016, 47(2): 490-498.
16. Jat KR, Walia DK, Khairwa A. Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis. Cochrane Database Syst Rev, 2018, 3: D10288.
17. Leon EE, Craig TJ. Antifungals in the treatment of allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol, 1999, 82(6): 511-516.
18. Zirbes JM, Milla CE. Steroid-sparing effect of omalizumab for allergic bronchopulmonary aspergillosis and cystic fibrosis. Pediatr Pulmonol, 2008, 43(6): 607-610.
19. Agarwal R, Gupta D, Aggarwal AN, et al. Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med, 2010, 104(2): 204-210.

Chinese Journal of Respiratory and Critical Care Medicine

A clinical analysis of 26 cases of allergic bronchopulmonary aspergillosis

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