Allergic Bronchopulmonary Aspergillosis with Aspergilloma: An Immunologically Severe Disease with Poor Outcome
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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.
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.
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.
The concurrent presentation of ABPA and aspergilloma is associated with an immunologically severe disease and risk of recurrent relapses.
KeywordsABPA Allergic bronchopulmonary aspergillosis Aspergillus fumigatus Aspergilloma Pulmonary aspergillosis Bronchial asthma
Conflicts of interest
- 18.Agarwal R, Garg M, Aggarwal AN, Saikia B, Gupta D, Chakrabarti A. Serologic allergic bronchopulmonary aspergillosis (ABPA-S): long-term outcomes. Respir Med. 2012;In press. doi: 10.1016/j.rmed.2012.03.001.
- 22.Standardization of Spirometry. Update. American Thoracic Society. Am J Respir Crit Care Med. 1995;152(3):1107–36.Google Scholar
- 23.Aggarwal AN, Gupta D, Jindal SK. Development of a simple computer program for spirometry interpretation. J Assoc Phys India. 2002;50:567–70.Google Scholar
- 48.Shah A, Bhagat R, Pant K, Jaggi OP, Khan ZU. Allergic bronchopulmonary aspergillosis with aspergilloma: exacerbation after prolonged remission. Indian J Tuberc. 1993;40(1):39–41.Google Scholar
- 49.Singh HJ, Bedi RS. Allergic bronchopulmonary aspergillosis with coexistant aspergilloma—a case report. Lung India. 1994;12(4):201–3.Google Scholar
- 50.Kumar R. Allergic bronchopulmonary aspergillosis with aspergilloma mimicking pulmonary tuberculosis. Ind J Tuberc. 2000;47:103–5.Google Scholar
- 51.Prasad R, Garg R, Sanjay, Shukla AD. Allergic broncho-pulmonary aspergillosis with aspergilloma developing in a cane sugar mill worker. Internet J Pulm Med. 2007;9(1).Google Scholar
- 53.Emmi L, Tinacci G, Stendardi L, Fiore A, Spinelli A, Scano G. Allergic bronchopulmonary aspergillosis and aspergilloma. Histopathological evidence. Allergol Immunopathol (Madr). 1988;16(3):193–6.Google Scholar