Allergic bronchopulmonary aspergillosis
Allergic bronchopulmonary aspergillosis ( ABPA ) is a triggered by molds of the genus Aspergillus ascomycete - shaped mixed allergic lung disease ( type I and type III allergy). One of the allergy-causing mold thereby include the types of Aspergillus fumigatus (common), Aspergillus flavus, Aspergillus niger, Aspergillus terreus and Aspergillus nidulans.
Especially ABPA occurs as a complication in cystic fibrosis ( cystic fibrosis). Here the ABPA affects at least ten to fifteen percent of patients, preferably from the second decade of life. To be distinguished is an allergic aspergillosis against infectious aspergillosis, which occurs mainly in patients with impaired immune response and is associated with a high mortality rate.
About the allergic bronchopulmonary aspergillosis reported for the first time Hinson et al. in 1952 in England. In the United States and Patterson Golbert diagnosed in the first case 1968.
Symptoms
The symptoms are obscure and rarely leaves a conclusion on the severity of the disease. ABPA occurs more often in people who already suffer from asthma or cystic fibrosis. Reports of ABPA without these pre-existing conditions are rare. The following symptoms may occur:
- Unexplained weight loss
- Brownish discolored sputum
- Fever usually more than three days
- Chest pain
The symptoms of the disease is easily confused with tuberculosis.
Diagnostics
The main criteria of ABPA are:
- Bronchial Asthma / Cystic Fibrosis
- Acute / prescribed pulmonary infiltrates
- Immediate reaction in the skin test to Aspergillus fumigatus
- Elevated total IgE in blood serum
- Antibodies against Aspergillus antigens
- Bluteosinophile
- Central bronchiectasis
Minor criteria:
- Aspergillus detection in sputum
- Late reaction in the skin test to Aspergillus fumigatus
The diagnostic method of choice remains the chest X-ray and possibly a high-resolution computed tomography ( CT), in which large-scale shading by a bronchial secretions ( mucoid impactions ) are visible and can also be observed central bronchiectasis usually.
Stages of the disease
In the literature, the ABPA is divided into five stages. The steps are not to be understood as phases, since a patient may already be at initial diagnosis in step five. In addition, a regression of stage III according to stage II is possible.
- Level I ( onset )
- Level II ( remission - temporary regression of symptoms)
- Stage III ( exacerbation - renewed deterioration )
- Stage IV ( kortikoidpflichtiges asthma)
- Level V (irreversible fibrotic changes of the lung tissue )
Therapy
Currently ABPA is treated with systemic steroid treatment ( cortisone ), possibly supported by an antifungal agent (eg, itraconazole). Case example, the administration of an antibiotic may be needed as the pulmonary infiltrates may be the seat of a bacterial pneumonia. A cure is not possible. It must be especially careful to avoid the widespread Aspergillus, such as the abolition of indoor plants, elimination or sealing of duvets and the abandonment of pets, especially birds.
Without treatment, develop scarred areas of the lung ( fibrosis ) that are no longer available for gas exchange. Therefore, a therapy must be aimed to prevent the development of stage V.