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Die allergisch-bronchopulmonale Aspergillose bei zystischer Fibrose

Evidenzbasiertes und konsensuelles Leitpapier zur Entscheidungsfindung bei der Diagnostik und Therapie

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Zusammenfassung

Die allergisch-bronchopulmonale Aspergillose (ABPA) bei Patienten mit zystischer Fibrose (CF) frühzeitig zu diagnostizieren bereitet häufig Schwierigkeiten, da die Klinik bei einem milden Verlauf einer ABPA oder einer schweren Form einer CF der jeweils anderen Erkrankung zugeschrieben werden kann. Dies kann die Erklärung für „klinisch stumme“ Fälle mit bereits deutlichen radiologischen und serologischen Veränderungen sein. Die Diagnose wird häufig erst nach Jahren und in einem späteren Stadium der Erkrankung gestellt. Ein gezieltes Screening, eine darauf aufbauende Diagnostik und eine rasch einsetzende Therapie sind notwendig.

In der Praxis Bewährtes und Studienergebnisse aus den letzten Jahren, die zu Verbesserungen der Diagnostik und Therapie führten, haben wir für den klinisch tätigen CF-Betreuer in einem Leitpapier zusammengefasst.

Abstract

Early diagnosis of allergic bronchopulmonary aspergillosis in patients suffering from cystic fibrosis (CF) is difficult because mild ABPA and severe forms of CF share common clinical features difficult to be clearly assigned to one of the diseases. This could explain “silent” cases of ABPA already showing distinct radiological and immunological changes not sufficient for a clear cut diagnosis of the disease. Therefore, the diagnosis of ABPA is often made in late stages compromising an efficient patient’s management. However, for disease management a reliable diagnostic screening followed by a rapid therapy would be essential. Classical diagnostic criteria established in clinical practice and new studies performed during the last years which contributed to an improved diagnosis and therapy of ABPA in CF are summarized here in a position paper aimed to help the clinicians treating CF patients in diagnosing ABPA.

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Literatur

  1. Allen MJ, Voelker DR, Mason RJ (2001) Interactions of surfactant proteins A and D with Saccharomyces cerevisiae and Aspergillus fumigatus. Infection and Immunity 69: 2037–2044

    Article  PubMed  Google Scholar 

  2. Baculard A, Scalbert M, Tassin E et al. (1994) A prospective study of A. fumigatus (AF) alergy and/or AF bronchopulmonary (BP) infection in children with cystic fibrosis (CF). Ped Pulm 10: A280

    Google Scholar 

  3. Bargon J, Dauletbaev N, Kohler B et al. (1999) Prophylactic antibiotic therapy is associated with an increased prevalence of Aspergillus colonization in adult cystic fibrosis patients. Respiratory Medicine 93: 835–838

    Article  PubMed  Google Scholar 

  4. Buchkowsky SS, Partovi N, Ensom MHH (2005) Clinical pharmacokinetic monitoring of itraconazole is warranted in only a subset of patients. Therapeutic Drug Monitoring 27: 322–333

    Article  PubMed  Google Scholar 

  5. Burns JL, Van Dalfsen JM, Shawar RM et al. (1999) Effect of chronic intermittent administration of inhaled tobramycin on respiratory microbial flora in patients with cystic fibrosis. Journal of Infectious Diseases 179: 1190–1196

    Article  PubMed  Google Scholar 

  6. Casadevall A, Pirofski LA (1999) Host-pathogen interactions: Redefining the basic concepts of virulence and pathogenicity. Infection and Immunity 67: 3703–3713

    PubMed  Google Scholar 

  7. Chauhan B, Santiago L, Hutcheson PS et al. (2000) Evidence for the involvement of two different MHC class II regions in susceptibility or protection in allergic bronchopulmonary aspergillosis. Journal of Allergy and Clinical Immunology 106: 723–729

    Article  PubMed  Google Scholar 

  8. Chung Y, Kraut JR, Stone AM, Valaitis J (1994) Disseminated Aspergillosis in A Patient with Cystic-Fibrosis and Allergic Bronchopulmonary Aspergillosis. Pediatric Pulmonology 17: 131–134

    PubMed  Google Scholar 

  9. Conway SP, Etherington C, Peckham DG et al. (2004) Pharmacokinetics and safety of itraconazole in patients with cystic fibrosis. Journal of Antimicrobial Chemotherapy 53: 841–847

    Article  PubMed  Google Scholar 

  10. Crameri R (1998) Recombinant Aspergillus fumigatus allergens: From the nucleotide sequences to clinical applications. International Archives of Allergy and Immunology 115: 99–114

    Article  PubMed  Google Scholar 

  11. Crameri R, Faith A, Hemmann S et al. (1996) Humoral and cell-mediated autoimmunity in allergy to Aspergillus fumigatus. Journal of Experimental Medicine 184: 265–270

    Article  PubMed  Google Scholar 

  12. Crameri R, Hemmann S, Ismail C et al. (1998) Disease-specific recombinant allergens for the diagnosis of allergic bronchopulmonary aspergillosis. International Immunology 10: 1211–1216

    Article  PubMed  Google Scholar 

  13. de Repentigny L, Ratelle J, Leclerc JM et al. (1998) Repeated-dose pharmacokinetics of an oral solution of itraconazole in infants and children. Antimicrobial Agents and Chemotherapy 42: 404–408

    PubMed  Google Scholar 

  14. De Wachter E, Malfroot A, De Schutter I et al. (2003) Inhaled budesonide induced Cushing’s syndrome in cystic fibrosis patients, due to drug inhibition of cytochrome P450. J Cystic Fibrosis 2: 72–75

    Article  Google Scholar 

  15. Denning DW, Vanwye JE, Lewiston NJ, Stevens DA (1991) Adjunctive Therapy of Allergic Bronchopulmonary Aspergillosis with Itraconazole. Chest 100: 813–819

    PubMed  Google Scholar 

  16. Franzen D, Boldt A, Sennekamp HJ (2003) A comparison of high resolution computerized tomography and magnetic resonance imaging in the evaluation of allergic bronchopulmonary aspergillosis. Pneumologie 57: 648–654

    Article  PubMed  Google Scholar 

  17. Geller DE, Kaplowitz H, Light MJ, Colin AA (1999) Allergic bronchopulmonary aspergillosis in cystic fibrosis - Reported prevalence, regional distribution, and patient characteristics. Chest 116: 639–646

    Article  PubMed  Google Scholar 

  18. Germaud P, Tuchais E, Canfrere I et al. (1992) Therapy of allergic bronchopulmonary aspergillosis with itraconazole. Am Rev Respir Dis 145: A736

    Google Scholar 

  19. Glasmacher A, Hahn C, Leutner C et al. (1999) Breakthrough invasive fungal infections in neutropenic patients after prophylaxis with itraconazole. Mycoses 42: 443–451

    Article  PubMed  Google Scholar 

  20. Greenberger PA (1994) Diagnosis and management of allergic bronchopulmonary aspergillosis. Allergy Proc 6: 335–339

    Google Scholar 

  21. Greenberger PA, Miller TP, Roberts M, Smith LL (1993) Allergic Bronchopulmonary Aspergillosis in Patients with and Without Evidence of Bronchiectasis. Annals of Allergy 70: 333–338

    PubMed  Google Scholar 

  22. Hemmann S, Nikolaizik WH, Schoni MH et al. (1998) Differential IgE recognition of recombinant Aspergillus fumigatus allergens by cystic fibrosis patients with allergic bronchopulmonary aspergillosis or Aspergillus allergy. European Journal of Immunology 28: 1155–1160

    Article  PubMed  Google Scholar 

  23. Hiller EJ (1990) Pathogenesis and Management of Aspergillosis in Cystic-Fibrosis. Archives of Disease in Childhood 65: 397–398

    PubMed  Google Scholar 

  24. Hinson KFW, Moon AJ, Plummer NS (1952) Broncho-Pulmonary Aspergillosis – A Review and A Report of 8 New Cases. Thorax 7: 317–333

    PubMed  Google Scholar 

  25. Hutcheson PS, Knutsen AP, Rejent AJ, Slavin RG (1996) A 12-year longitudinal study of Aspergillus sensitivity in patients with cystic fibrosis. Chest 110: 363–366

    PubMed  Google Scholar 

  26. Hutcheson PS, Rejent AJ, Slavin RG (1991) Variability in Parameters of Allergic Bronchopulmonary Aspergillosis in Patients with Cystic-Fibrosis. Journal of Allergy and Clinical Immunology 88: 390–394

    Article  PubMed  Google Scholar 

  27. Jennings TS, Hardin TC (1993) Treatment of Aspergillosis with Itraconazole. Annals of Pharmacotherapy 27: 1206–1211

    PubMed  Google Scholar 

  28. Knutsen AP, Bellone C, Kauffmann H (2002) Immunopathogenesis of allergic bronchopulmonary aspergillosis in cystic fibrosis. J Cystic Fibrosis 1: 76–89

    Article  Google Scholar 

  29. Laufer P, Fink JN, Bruns WT et al. (1984) Allergic Bronchopulmonary Aspergillosis in Cystic-Fibrosis. Journal of Allergy and Clinical Immunology 73: 44–48

    Article  PubMed  Google Scholar 

  30. Logan PM, Muller NL (1996) High-attenuation mucous plugging in allergic bronchopulmonary aspergillosis. Canadian Association of Radiologists Journal-Journal de l Association Canadienne des Radiologistes 47: 374–377

    Google Scholar 

  31. Maguire CP, Hayes JP, Hayes M et al. (1995) 3 Cases of Pulmonary Aspergilloma in Adult Patients with Cystic-Fibrosis. Thorax 50: 805–806

    PubMed  Google Scholar 

  32. Mannes GPM, Vanderheide S, Vanaalderen WMC, Gerritsen J (1993) Itraconazole and Allergic Bronchopulmonary Aspergillosis in Twin Brothers with Cystic-Fibrosis. Lancet 341: 492

    Article  PubMed  Google Scholar 

  33. Mastella G, Rainisio M, Harms HK et al. (2000) Allergic bronchopulmonary aspergillosis in cystic fibrosis. A European epidemiological study. European Respiratory Journal 16: 464–471

    Article  PubMed  Google Scholar 

  34. Matthieson AM (1981) Allergic bronchopulmonary disease caused by fungi other than aspergillus. Thorax 36: 719

    Google Scholar 

  35. Mearns M, Young W, Batten J (1965) Transient Pulmonary Infiltrations in Cystic Fibrosis Due to Allergic Aspergillosis. Thorax 20: 385

    Google Scholar 

  36. Moss RB (2002) Allergic bronchopulmonary aspergillosis. Clinical Reviews in Allergy & Immunology 23: 87–104

    Google Scholar 

  37. Nelson LA, Callerame ML, Schwartz RH (1979) Aspergillosis and Atopy in Cystic-Fibrosis. American Review of Respiratory Disease 120: 863–873

    PubMed  Google Scholar 

  38. Nepomuceno IB, Esrig S, Moss RB (1999) Allergic bronchopulmonary aspergillosis in cystic fibrosis – Role of atopy and response to itraconazole. Chest 115: 364–370

    Article  PubMed  Google Scholar 

  39. Ng TTC, Robson GD, Denning DW (1994) Hydrocortisone-Enhanced Growth of Aspergillus Spp – Implications Far Pathogenesis. Microbiology-Uk 140: 2475–2479

    Google Scholar 

  40. Nikolaizik WH, Brueton MJ, Warner JO (1991) Aspergillus allergy and allergy and allergic bronchopulmonary aspergillosis in cystic fibrosis. Pediatr Allergy Immunol 2: 86

    Google Scholar 

  41. Nikolaizik WH, Weichel M, Blaser K, Crameri R (2002) Intracutaneous tests with recombinant allergens in cystic fibrosis patients with allergic bronchopulmonary aspergillosis and Aspergillus allergy. American Journal of Respiratory and Critical Care Medicine 165: 916–921

    PubMed  Google Scholar 

  42. Parmar JS, Howell T, Kelly J, Bilton D (2002) Profound adrenal suppression secondary to treatment with low dose inhaled steroids and itraconazole in allergic bronchopulmonary aspergillosis in cystic fibrosis. Thorax 57: 749–750

    Article  PubMed  Google Scholar 

  43. Schwartz RH, Hollick GE (1981) Allergic Bronchopulmonary Aspergillosis (Abpa) with Low Serum Ige. Pediatric Research 15: 603

    Google Scholar 

  44. Sermet-Gaudelus I, Lesne-Hulin A, Lenoir G et al. (2001) Sputum itraconazole concentrations in cystic fibrosis patients. Antimicrobial Agents and Chemotherapy 45: 1937–1938

    Article  PubMed  Google Scholar 

  45. Skov M, Main KM, Sillesen IB et al. (2002) Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide. European Respiratory Journal 20: 127–133

    Article  PubMed  Google Scholar 

  46. Stevens DA, Moss RB, Kurup VP et al. (2003) Allergic bronchopulmonary aspergillosis in cystic fibrosis – State of the art: Cystic Fibrosis Foundation Consensus Conference. Clinical Infectious Diseases 37: S225–S264

    Article  PubMed  Google Scholar 

  47. Stevens DA, Schwartz HJ, Lee JY et al. (2000) A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis. New England Journal of Medicine 342: 756–762

    Article  PubMed  Google Scholar 

  48. Vaughan LM (1993) Allergic Bronchopulmonary Aspergillosis. Clinical Pharmacy 12: 24–33

    PubMed  Google Scholar 

  49. Wark P (2004) Pathogenesis of allergic bronchopulmonary aspergillosis and an evidence-based review of azoles in treatment. Respiratory Medicine 98: 915–923

    Article  PubMed  Google Scholar 

  50. Zeaske R, Bruns WT, Fink JN et al. (1988) Immune-Responses to Aspergillus in Cystic-Fibrosis. Journal of Allergy and Clinical Immunology 82: 73–77

    Article  PubMed  Google Scholar 

  51. Elliott CH, Jay SM, Woody P (1987) An observation scale for measuring children’s distress during medical procedures. J Pediatr Psychol 12: 543–551

    PubMed  Google Scholar 

  52. Pretzlik U, Sylva K (1999) Paediatric patients’ distress and coping: an observational measure. Arch Dis Child 81: 528–530

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Universitätsklinik für Kinder- und Jugendheilkunde Paracelsus Medizinische Privatuniversität, Salzburg, Österreich

    I. Huttegger

  2. Schweizerisches Institut für Allergie- und Asthmaforschung-SIAF, Davos, Schweiz

    R. Crameri

  3. Abteilung für Allgemeine Pädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Österreich

    I. Eichler

  4. Mukoviszidose-Zentrum und spez. Infektiologie, Universitätsklinik für Kinder- und Jugendmedizin, Heidelberg, Deutschland

    F.-M. Müller

  5. Zentrum für Kinderheilkunde, Justus-Liebig-Universität, Giessen, Deutschland

    H. Lindemann

  6. Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80336, München, Deutschland

    M. Griese

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  1. I. Huttegger
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  2. R. Crameri
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  3. I. Eichler
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  4. F.-M. Müller
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  5. H. Lindemann
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  6. M. Griese
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Correspondence to M. Griese.

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Die oben genannten Autoren stehen für die AG Mukoviszidose der Gesellschaft für Pädiatrische Pneumologie e.V.

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Huttegger, I., Crameri, R., Eichler, I. et al. Die allergisch-bronchopulmonale Aspergillose bei zystischer Fibrose . Monatsschr Kinderheilkd 154, 1003–1014 (2006). https://doi.org/10.1007/s00112-006-1417-1

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