Pulmonary aspergillosis - allergic bronchopulmonary type

An allergic reaction to a fungus called aspergillus which causes inflammation of the airways and air sacs of the lungs.

Alternative Names

Aspergillosis - allergic bronchopulmonary; Allergic bronchopulmonary aspergillosis; ABPA

Causes, incidence, and risk factors

The aspergillus fungus is common. It can grow on dead leaves, stored grain, bird droppings, compost stacks and other decaying vegetation. Although most people are frequently exposed to aspergillus, infections caused by it such as a pneumonia or fungus ball ( aspergilloma ) are rare. Some people, however, have an allergic reaction (hypersensitivity) to this fungus, which is called allergic bronchopulmonary aspergillosis (ABPA). It is characterized by inflammation of the airways (bronchi) or air sacs (alveoli). The disease may mimic asthma or pneumonia, and, in fact, most patients with ABPA have asthma as well. Patients with asthma or cystic fibrosis are at highest risk for allergic aspergillosis.

Signs and tests

  • elevated
  • CBC eosinophil count
  • elevated serum IgE antibodies: total IgE level and level of IgE specific for aspergillus
  • aspergillus antigen skin test
  • positive serum aspergillus
  • antibodies
  • chest X-ray
  • showing infiltrates and finger-like shadows
  • chest CAT scan showing central bronchiectasis (dilation of the airways) or mucous plugging
  • sputum stain and culture for fungus
  • bronchoscopy with cultures and transbronchial biopsy
  • rarely lung biopsy is required
  • Treatment

    Allergic aspergillosis is treated with oral prednisone. The anti-fungal antibiotic, itraconazole, can also be helpful. People with asthma should also continue their usual inhaler treatments.

    Expectations (prognosis)

    The response to therapy is usually good, with improvement over time. Relapses requiring repeat treatment are common.

    Complications

  • irreversible
  • airway obstruction
  • bronchiectasis
  • mucous plugging
  • respiratory
  • failure
  • Calling your health care provider

    Call your health care provider if symptoms of this disorder develop. Call your health care provider if breathing becomes more difficult. Severe breathing difficulty is an emergency.

    Prevention

    People with predisposing factors ( asthma , cystic fibrosis , etc.) should try to avoid environments where this fungus is found if possible.

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