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Updated: Aug 18, 2026
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
[Allergic bronchopulmonary aspergillosis in asthma and cystic fibrosis]
J H L van Hoorn1, J J E Hendriks, E Dompeling
1Academisch Ziekenhuis, afd. Kindergeneeskunde, Postbus 5800, 6202 AZ, Maastricht.
Insights
Diagnosing allergic bronchopulmonary aspergillosis (ABPA) in children with asthma or cystic fibrosis (CF) is challenging. Early ABPA diagnosis and treatment are crucial to prevent long-term lung damage.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Allergy and Immunology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease that occurs in some people with asthma or cystic fibrosis (CF).
- Early diagnosis and management of ABPA are essential to prevent irreversible lung damage and fibrosis.
- Treatment strategies for ABPA often involve corticosteroids and antifungal agents, but dilemmas can arise regarding long-term use and efficacy.
Observation:
- This report details three pediatric cases of ABPA complicating asthma or CF.
- Case 1: A 14-year-old boy with CF presented with hemoptysis and decreased lung function, improving with prednisone-itraconazole after antibiotic failure.
- Case 2: A 16-year-old girl with CF and ABPA experienced symptom exacerbation upon prednisone reduction, leading to treatment cessation due to side effects, followed by a recurrence of ABPA.
- Case 3: A 16-year-old boy with asthma likely had an ABPA episode presenting as an asthma exacerbation.
Findings:
- The cases highlight the diagnostic difficulties associated with ABPA in pediatric patients with underlying respiratory conditions.
- Treatment with prednisone and itraconazole showed initial efficacy but also presented challenges, including side effects and potential for recurrence.
- The importance of considering ABPA in the differential diagnosis of worsening respiratory symptoms in asthmatic or CF patients is underscored.
Implications:
- Accurate and timely diagnosis of ABPA in children with asthma and CF is critical for effective management.
- Treatment decisions for ABPA require careful consideration of balancing efficacy with potential side effects and the risk of disease recurrence.
- Further research into optimal diagnostic and therapeutic strategies for pediatric ABPA is warranted to improve patient outcomes and prevent fibrotic lung disease.
Abstract:
Three children developed allergic bronchopulmonary aspergillosis (ABPA) as a complication of either asthma or cystic fibrosis (CF). The first patient was a 14-year-old boy with CF who presented with an episode of haemoptysis and a decrease in lung function. He was initially treated with intravenous antibiotics but there was no improvement of his lung function. After starting prednisone-itraconazole his condition improved substantially. The second patient was a 16-year-old girl with CF complicated by ABPA. She was treated for 2 years with prednisone-itraconazole. Although the symptoms worsened when the prednisone dosage was gradually reduced, her growth retardation and increased weight decided us to stop prednisone treatment. Two years later, her CF was once again complicated by ABPA. The third patientwas a 16-year-old boy with asthma who had initially been treated for an asthma exacerbation. In retrospect, the cause of his pulmonary exacerbation was probably an ABPA episode. These cases illustrate how important but also how difficult the early diagnosis of ABPA is, and the dilemmas faced in treatment to prevent the fibrotic end stage.
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