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Pathology of allergic bronchopulmonary aspergillosis
1Department of Pediatrics, Floating Hospital for Children, New England Medical Center, Boston, MA 02111, USA. achetty@lifespan.org
Abstract:
Allergic bronchopulmonary aspergillosis (ABPA) occurs in patients with asthma and cystic fibrosis when Aspergillus fumigatus spores are inhaled and grow in bronchial mucus as hyphae. Chronic colonization of Aspergillus fumigatus and host's genetically determined immunological response lead to ABPA. In most cases, lung biopsy is not necessary because the diagnosis is made on clinical, serologic, and roentgenographic findings. Some patients who have had lung biopsies or partial resections for atelectasis or infiltrates will have histologic diagnoses. A number of different histologic diagnoses can be found even in the same patient. In the early stages the bronchial wall is infiltrated with mononuclear cells and eosinophils. Mucoid impaction and eosinophilic pneumonia are seen subsequently. This may be followed by bronchiolitis obliterans, granulomatous bronchiolitis, and pulmonary fibrosis. Treatment with corticosteroids appears to prevent the progression of the disease.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) is an immune response to Aspergillus fumigatus in asthma and cystic fibrosis patients. Corticosteroid treatment may halt disease progression.
Area of Science:
- Pulmonology
- Immunology
- Infectious Diseases
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder affecting the lungs.
- It is primarily diagnosed in patients with asthma and cystic fibrosis.
- Inhaled Aspergillus fumigatus spores trigger an immune response, leading to chronic colonization and inflammation.
Purpose of the Study:
- To describe the pathogenesis, diagnosis, and histological findings of Allergic bronchopulmonary aspergillosis.
- To highlight the role of Aspergillus fumigatus in the development of ABPA.
- To discuss the potential of corticosteroid treatment in managing ABPA.
Main Methods:
- Review of clinical, serologic, and roentgenographic diagnostic criteria for ABPA.
- Analysis of histological findings from lung biopsies and resections in ABPA patients.
- Evaluation of the impact of corticosteroid therapy on disease progression.
Main Results:
- ABPA diagnosis typically relies on clinical, serologic, and imaging findings, often negating the need for lung biopsy.
- Histological examination can reveal diverse findings, including eosinophilic and mononuclear cell infiltration, mucoid impaction, eosinophilic pneumonia, bronchiolitis obliterans, granulomatous bronchiolitis, and pulmonary fibrosis.
- Corticosteroid treatment shows promise in preventing disease advancement.
Conclusions:
- ABPA results from a specific immune response to Aspergillus fumigatus in susceptible individuals.
- Histological findings in ABPA are varied and can evolve over time.
- Corticosteroids represent a key therapeutic strategy for managing ABPA and preventing its progression.