Allergic bronchopulmonary aspergillosis: a retrospective study of 35 cases

Clinical profile of 35 patients with allergic bronchopulmonary aspergillosis (ABPA) was analysed. The disease was found to be more frequent among females. Constitutional symptoms, expectoration, increased breathless and poor control of asthma were the main presenting features. Skin reactivity against aspergillin and Candida was positive in 30 and 2 cases, respectively. Precipitating antibodies against Aspergillus species was positive in 28 cases, and against Candida albicans in 2 cases. Sputum grew either Aspergillus or C. albicans or both in 19 patients. Absolute eosinophilia was observed only in one third of cases. Chest skiagram revealed characteristic central/proximal bronchiectasis and/or fleeting shadows in all cases. No specific pattern was observed on spirometry. There was no correlation between the duration of bronchial asthma, sputum culture and serology results. Most patients responded well to steroids. One striking feature of the study was that one third of the cases were misdiagnosed as pulmonary tuberculosis and were treated with antitubercular drugs for varying periods of time. A high index of clinical suspicion with appropriate laboratory tests are required to identify these cases.