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Aspergillus-associated hypersensitivity respiratory disorders.

Ashok Shah1

  • 1Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India. ashokshah99@yahoo.com

The Indian Journal of Chest Diseases & Allied Sciences
|July 10, 2008
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Summary
This summary is machine-generated.

Aspergillus mould causes various respiratory conditions, including asthma and allergic bronchopulmonary aspergillosis (ABPA). Early screening of asthmatics for Aspergillus sensitization can identify severe disease and those at risk for ABPA.

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Area of Science:

  • Medical Mycology
  • Pulmonology
  • Allergy and Immunology

Background:

  • The mould Aspergillus is a significant cause of respiratory diseases, ranging from colonization to invasive infections.
  • Aspergillus-associated hypersensitivity disorders include asthma, allergic bronchopulmonary aspergillosis (ABPA), allergic Aspergillus sinusitis (AAS), and hypersensitivity pneumonitis.
  • Fungal spores are increasingly recognized as critical inhalant allergens in patients with allergic asthma, exacerbating airway inflammation.

Purpose of the Study:

  • To elucidate the diverse clinical spectrum of Aspergillus-associated respiratory diseases.
  • To highlight the link between Aspergillus sensitization and severe asthma, as well as the risk of developing ABPA.
  • To emphasize the diagnostic challenges and increasing recognition of co-existing conditions like ABPA and AAS.

Main Methods:

  • Review of clinical presentations and diagnostic criteria for Aspergillus-induced asthma, ABPA, and AAS.
  • Discussion of radiological features and differential diagnoses, particularly with pulmonary tuberculosis.
  • Analysis of the immunological mechanisms and epidemiological associations between different Aspergillus-related conditions.

Main Results:

  • Aspergillus sensitization is linked to more severe forms of asthma, with spores trapped in airway secretions.
  • Allergic bronchopulmonary aspergillosis (ABPA) is an emerging disease, particularly in India, characterized by central bronchiectasis.
  • Allergic Aspergillus sinusitis (AAS) presents with mucoid impaction and shares histopathological features with ABPA, with increasing recognition of their co-existence.

Conclusions:

  • Screening asthmatic individuals for Aspergillus sensitization is crucial for identifying severe disease and those at risk of ABPA.
  • Concomitant occurrence of ABPA and AAS is increasingly recognized and AAS should be excluded in ABPA patients.
  • Aspergilloma, a fungal ball, can act as a nidus for antigenic stimulation, potentially leading to ABPA in susceptible individuals.