Λεξικό .. Allergic Bronchopulmonary Aspergillosis, (A.B.P.A.)

A.B.P.A. is a condition that occurs secondary to a complex  immunologic reaction to inhaled spores of the ubiquitous fungus, Aspergillus fumigatus. The growing Aspergillus releases antigens which apparently leads to the resulting pathophysiology. The population prevalence of ABPA is not clearly known, but the prevalence in asthma clinics is reported to be around 13%. Clinically the patient has asthma, complicated by episodes of fever, cough, purulent sputum, and brown sputum plugs. Chest x-ray films usually reveal migratory (especially traits or atelectasis or both). Sputum examination shows eosinophilia and hyphae. Sputum cultures grow Aspergillus. The peripheral eosinophilia is greater than 500/mm3 and IgE level greater than 2000 ng/ml.

Prick tests with an Aspergillus skin test are positive, a later (4 to 6 hours) swelling and erythema may follow, and precipitating antibody against Aspergillus antigen is demonstrable in the serum. Pathologically has been reported eosinophilic pneumonia, mucus plugging, interstitial pneumonitis and bronchocentric granulomatosis. The immunopathogenesis of A.B.P.A. appears to result from a combination of Type I and Type III immunologic reactions in and around bronchial walls. Treatment of choice is the administration of corticosteroids.  (See Aspergillus fumigatus). The disorder needs to be detected before bronchiectasis has developed because the occurrence of bronchiectasis is associated with poorer outcomes. Because many patients with ABPA may be minimally symptomatic or asymptomatic, a high index of suspicion for ABPA should be maintained while managing any patient with bronchial asthma whatever the severity or the level of control. This underscores the need for routine screening of all patients with asthma with an Aspergillus skin test.

References
Agarwal R. Allergic bronchopulmonary aspergillosis. Chest. 2009 Mar;135(3):805-26.