Allergic bronchopulmonary aspergillosis: a clinico-serological correlation with radiologic profile

To study the different types of radiological presentations of ABPA in a tertiary clinic in Northern India and analyze them with respect to serological profile and clinical characteristics.

We performed a retrospective analysis of clinical, serological and radiological characteristics of ABPA patients registered at a unit of tertiary pulmonary care center in North India. The patients were classified based on radiological presentation into ABPA-S, ABPA-CB and ABPA-CB-ORF and the differences in these groups were studied.

There were 112 patients with ABPA between age 6 and 75 years. About 8.9% (n = 10) of patients had a history of smoking and 38.4% (n = 43) had a history of prior anti-tuberculosis treatment. The median duration of symptoms was longest in the ABPA-CB-ORF group (15 years) followed by ABPA-CB (7 years) and ABPA-S (5 years). Mean serum total IgE level in the ABPA-CB-ORF group was 14 330 IU/mL followed by the APBA-CB (3700 IU/mL) and ABPA-S (1020 IU/mL) groups (p < 0.0001). The ABPA-CB-ORF group had the highest median specific anti-Aspergillus fumigatus IgE followed by ABPA-CB and ABPA-S groups (42.24 kU/L, 20.65 kU/L and 3.44 kU/L, respectively) (p < 0.0001). ABPA-CB-ORF group had the highest percentage of positive serum precipitins against Aspergillus spp. (92%) followed by ABPA-CB (79.6%) and ABPA-S (68%) (p < 0.05).

The patients with more pronounced lung damage in the form of ABPA-CB and ABPA-CB-ORF had higher serological parameters suggestive of increased systemic inflammation. Hence, ABPA may be categorized as mild (ABPA-S), moderate (ABPA-CB) and severe (ABPA-CB-ORF) categories which oscillate between remission and exacerbation phases.