A review of 42 asthmatic children with allergic bronchopulmonary aspergillosis
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1Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110 007, India.
Insights
Pediatric allergic bronchopulmonary aspergillosis (ABPA) is often overlooked in children with asthma. Early evaluation for ABPA and allergic Aspergillus sinusitis (AAS) is crucial for accurate diagnosis and management.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Medical Imaging
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is underrecognized in pediatric asthma patients without cystic fibrosis.
- This condition requires greater clinical attention and diagnostic focus.
Purpose of the Study:
- To characterize the presentation and diagnostic features of ABPA in children with asthma.
- To emphasize the importance of considering ABPA and associated allergic Aspergillus sinusitis (AAS) in this population.
Main Methods:
- Retrospective review of pediatric ABPA cases over 31 years.
- Screening included asthma, eosinophilia, chest radiograph infiltrates, and specific allergy testing.
- Diagnostic tools comprised bronchography/CT scans for central bronchiectasis and paranasal sinus imaging.
Main Results:
- 42 pediatric patients (12.03%) were diagnosed with ABPA, with a mean age of 12.9 years.
- Central bronchiectasis was identified in 32 patients; ring shadows were common radiologically.
- Sinusitis was present in 20/30 patients with upper airway symptoms, with 8 suspected of AAS.
Conclusions:
- Asthmatic children require evaluation for ABPA.
- Exclusion of allergic Aspergillus sinusitis (AAS) is also essential in the diagnostic workup.
Background:
Allergic bronchopulmonary aspergillosis (ABPA) in children with asthma, not associated with cystic fibrosis, is yet to receive the recognition it deserves.
Objective:
To highlight the presentation of ABPA in children with asthma.
Methods:
This retrospective review documents the occurrence of pediatric ABPA over a period of 31 years in one unit. Children with asthma, eosinophilia and infiltrates on chest radiograph were screened for ABPA. In these patients, demonstration of immediate hypersensitivity response against Aspergillus species along with serological profile and pulmonary function testing were done. Bronchography/computed tomography (CT) of the chest demonstrated central bronchiectasis (CB). CT of the paranasal sinuses was done in patients with upper airways symptoms. In those suspected with allergic Aspergillus sinusitis (AAS) consent was sought from the parents for the invasive procedure needed for the diagnosis of AAS.
Results:
Of the 349 patients with ABPA diagnosed, 42 (12.03%) were in the pediatric age group. The mean age on presentation was 12.9 ± 4 years with a male preponderance. All patients had asthma and positive intradermal/skin prick test against Aspergillus species. Ring shadows, the most common radiological presentation, were seen in 28 of 42 patients. Bronchography/CT of the chest demonstrated CB, a feature pathognomic of ABPA, in 32 of 42 patients. High attenuation mucus plugs was observed in 7 of 36 patients while ABPA-seropositive was diagnosed in 10 of 42 patients. On imaging, sinusitis was seen in 20 of 30 patients with upper airways symptoms of whom eight had suspected AAS. Three parents consented for surgery, which confirmed the diagnosis.
Conclusion:
This study highlights the need to evaluate asthmatic children for ABPA as also to exclude AAS.
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