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[Allergic bronchopulmonary aspergillosis. Apropos of 30 cases]
Abstract:
Thirty cases of allergic bronchopulmonary aspergillosis (ABPA) were treated between 1967 and 1981. Developing in patients with a history of chronic asthma (28 of the 30 cases), the initial manifestations of ABPA developed after long periods (an average of 29 years after the onset of the asthma). Chest radiography demonstrated recurrent labile infiltrates in 28 cases, segmental or lobar atelectasis in 7, and proximal bronchiectasis in 16 cases. A circulating eosinophilia was a constant finding, but this varied with time. Immunologic investigations gave positive skin tests, 19 of the 30 patients only presenting a cutaneous reaction delayed until the 6th hour. Total IgE, determined in 18 cases, varied between 600 and 9400 IU/ml (RIST), with identification of specific IgE for Aspergillus in all cases, though to varying degrees. Serial measurements of total IgE levels showed co-existence of an acute progression of the affection and elevated total IgE in 3 cases, but no correlation was found between serum IgE levels and the severity or chronicity of the disease. Physiopathologic features included immediate and partially delayed hypersensitivity to Aspergillus fumigatus. The frequency of ABPA during the course of mucoviscidosis suggests, by analogy, that a local factor may exist which favorizes Aspergillus fumigatus proliferation in patients with ABPA alone.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) often develops years after chronic asthma onset. Diagnosis involves eosinophilia, elevated IgE, and hypersensitivity to Aspergillus fumigatus.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Infectious Diseases
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity lung disease.
- It primarily affects patients with chronic asthma, often developing decades after asthma onset.
- Understanding ABPA's clinical and immunological features is crucial for diagnosis and management.
Purpose of the Study:
- To analyze the clinical characteristics and immunological findings in patients with ABPA.
- To investigate the relationship between ABPA and chronic asthma.
- To explore potential factors contributing to Aspergillus fumigatus proliferation.
Main Methods:
- Retrospective analysis of 30 ABPA cases treated between 1967 and 1981.
- Review of patient histories, focusing on asthma duration and ABPA onset.
- Evaluation of chest radiography findings, including infiltrates, atelectasis, and bronchiectasis.
- Assessment of immunological markers: circulating eosinophilia, skin tests, and total and specific IgE levels.
Main Results:
- ABPA developed in 28 of 30 asthma patients, with an average delay of 29 years after asthma onset.
- Common radiographic findings included recurrent infiltrates (28 cases) and proximal bronchiectasis (16 cases).
- Constant eosinophilia, positive skin tests (immediate and delayed), and elevated total IgE (600-9400 IU/ml) with specific IgE to Aspergillus were observed.
Conclusions:
- ABPA presents with diverse clinical and immunological features, including eosinophilia and IgE-mediated hypersensitivity to Aspergillus fumigatus.
- The long delay between asthma onset and ABPA suggests a complex, possibly localized, predisposition to fungal proliferation.
- Further research into local factors may elucidate the pathogenesis of ABPA in susceptible individuals.