Allergic bronchopulmonary aspergillosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to bronchial colonization by Aspergillus fumigatus mold, typically affecting patients with an underlying predisposition, specifically asthma or cystic fibrosis.
When predisposed individuals inhale the aspergillus spores, which are ubiquitous in the environment, the spores germinate in the lungs, setting off a complex immune cascade which results in the formation of immunoglobulin E and immunoglobulin G antibodies and immune-mediated lung destruction.
ABPA usually presents in a similar way to asthma but may be complicated by bronchial obstruction, fever, malaise, expectoration of brownish mucus plugs, peripheral blood eosinophilia, and hemoptysis in later stages.
Treatment involves corticosteroids with or without antifungal therapy. Monoclonal antibodies used for the treatment of asthma are under active investigation as a promising alternative treatment for ABPA.
Early diagnosis and rapid initiation of treatment can prevent the development of bronchiectasis or pulmonary fibrosis that otherwise occurs in the later stages of the disease.

Chest x-ray in a patient with ABPA: ring shadows (long arrows) represent bronchiectatic airways seen in cross-section; tram lines (short arrow) seen longitudinally

From American College of Chest Physicians. PCCU Volume 17, Lesson 17: Allergic bronchopulmonary aspergillosis. Used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Chest x-ray in a patient with ABPA: ring shadows (long arrows) represent bronchiectatic airways seen in cross-section; tram lines (short arrow) seen longitudinally
Chest x-ray in a patient with ABPA: classic glove-finger pattern represents central bronchiectatic airways impacted with mucus
CT chest in a patient with ABPA: dilated, mucoid-impacted bronchiectatic airways
CT chest in a patient with ABPA: glove-finger shadow due to mucoid impaction in central bronchiectasis in a patient with asthma

Citations

Key Articles

Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-e60.[Abstract][Full Text]
Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65(suppl 1):i1-i58.[Abstract][Full Text]
Cystic Fibrosis Foundation. Allergic bronchopulmonary aspergillosis clinical care guidelines. 2003 [internet publication].[Full Text]

Referenced Articles

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