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Mycopathologia

, Volume 174, Issue 3, pp 193–201 | Cite as

Allergic Bronchopulmonary Aspergillosis with Aspergilloma: An Immunologically Severe Disease with Poor Outcome

  • Ritesh AgarwalEmail author
  • Ashutosh N. Aggarwal
  • Mandeep Garg
  • Biman Saikia
  • Dheeraj Gupta
  • Arunaloke Chakrabarti
Article

Abstract

Background and Aims

The association between allergic bronchopulmonary aspergillosis (ABPA) and aspergilloma has been proposed as a severe form of ABPA. However, this conclusion is based on single-patient case reports. In this study, we describe the clinical details and immunological findings of this association and compare patients of ABPA with aspergilloma and those without.

Methods

This is a retrospective analysis of data of patients with ABPA managed in the Chest Clinic. We compared the clinical, radiological and immunological profile of patients with ABPA and central bronchiectasis, with and without the presence of aspergilloma on HRCT scan.

Results

There were 98 men and 81 women with a mean (SD) age of 33.6 (12.2) years. Eight patients were diagnosed to have aspergilloma. Sputum cultures grew Aspergillus fumigatus in all these eight patients. The aspergilloma was solitary in six patients, and two each in two patients. Patients with aspergilloma had higher IgE levels (both total and A. fumigatus specific) than those without aspergilloma. Bronchiectasis was also more extensive in patients with aspergilloma. Overall, 70 % of the ABPA patients experienced relapse during the median (interquartile range) follow-up of 27 (19–39) months. The number of relapses was significantly higher in patients with aspergilloma (p = 0.0001). On a multivariate linear regression analysis, high-attenuation mucus and aspergilloma were independent predictors of relapse frequency.

Conclusions

The concurrent presentation of ABPA and aspergilloma is associated with an immunologically severe disease and risk of recurrent relapses.

Keywords

ABPA Allergic bronchopulmonary aspergillosis Aspergillus fumigatus Aspergilloma Pulmonary aspergillosis Bronchial asthma 

Notes

Conflicts of interest

None.

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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Ritesh Agarwal
    • 1
    Email author
  • Ashutosh N. Aggarwal
    • 1
  • Mandeep Garg
    • 2
  • Biman Saikia
    • 3
  • Dheeraj Gupta
    • 1
  • Arunaloke Chakrabarti
    • 4
  1. 1.Department of Pulmonary MedicinePostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of RadiodiagnosisPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of ImmunopathologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  4. 4.Department of Medical MicrobiologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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