Allergic Bronchopulmonary Aspergillosis (ABPA) diagnosis criteria Treatment: Allergic bronchopulmonary aspergillosis (ABPA), also known as allergic bronchopulmonary Mycosis, is the most common and characteristic disease of allergic bronchial fungal disease, first reported in the United Kingdom in 1952. Allergic Bronchopulmonary Aspergillosis (ABPA) diagnosis criteria Treatment. Its pathogenic Aspergillus is most common with Aspergillus fumigatus, and it can be seen by Aspergillus flavus, Aspergillus oryzae, and Aspergillus terreus. The main symptoms in the acute phase are wheezing, hemoptysis, purulent sputum, fever, chest pain and coughing brown sputum. Allergic Bronchopulmonary Aspergillosis (ABPA) diagnosis criteria Treatment.
Table of Content:
1: Allergic Bronchopulmonary Aspergillosis Causes
2: Allergic Bronchopulmonary Aspergillosis Symptoms
3: Allergic Bronchopulmonary Aspergillosis Test
4: Allergic Bronchopulmonary Aspergillosis Diagnosis
5: Allergic Bronchopulmonary Aspergillosis Diagnosis Criteria
6: Allergic Bronchopulmonary Aspergillosis Treatment
1: Allergic Bronchopulmonary Aspergillosis Causes:
Most cases of ABPA are caused by a high allergy to Aspergillus, especially Aspergillus fumigatus is the most common. Inhalation of high concentrations of Aspergillus fumigatus spores in atopic individuals sensitive to Aspergillus is the main pathogenic path of the disease.
2: Allergic Bronchopulmonary Aspergillosis Symptoms:
The main symptoms in the acute phase are wheezing, hemoptysis, purulent sputum, fever, chest pain and coughing brown sputum. The majority of hemoptysis is blood stasis, but a small number of patients have a large amount of hemoptysis. Symptoms in the acute phase last longer, often require half a year of hormone therapy to resolve, and a few cases evolve into a hormone-dependent phase. Due to the different definitions of acute attacks, their frequency of occurrence is different. ABPA Although asthma mild symptoms, but nearly half of patients require long-term inhalation or topical corticosteroid.
2. Atypical performance:
Occasionally, ABPA and Aspergillus are present at the same time. In a very small number of patients, ABPA
can also spread outside the lungs, such as brain invasion, increased cerebrospinal fluid lymph, pleural effusion.
3. The clinical course of ABPA is divided into 5 phases:
Not every patient has to go through a phase 5 clinical course.
The first phase (acute phase) is characterized by paroxysmal symptoms such as wheezing, fever, and weight loss. IgE levels were significantly elevated, eosinophilia, pulmonary infiltrates, serum IgE-Af and IgG-Af positive.
Stage II (remission period) usually relies on bronchodilators and inhaled corticosteroids to control symptoms, chest X-rays are normal, serum IgE-Af and IgG-Af are not significantly elevated or slightly elevated, serum IgE levels are reduced but Did not return to normal, no eosinophilia. After 6 to 12 weeks of treatment, serum IgE decreased by 35% to 50% or after 6 to 9 months of oral glucocorticoid treatment. After more than 3 months, no exacerbation can be defined as “complete remission”.
In stage III (exacerbation period), most patients showed acute symptoms. Some patients had an asymptomatic recurrence. Only the serum total IgE increased more than 2 times or new infiltrates appeared in the lungs. Therefore, this period should be closely monitored.
Stage IV (hormone-dependent phase) manifests as hormone-dependent asthma. Asthma symptoms must be controlled by oral glucocorticoids, and asthma is aggravated when hormones are reduced. Even if asthma is relieved, it is difficult to stop the drug. Serum IgE levels are elevated or normal. Usually, there is no lung infiltrates on the X-ray, but a few patients have a variety of chest radiographs, which may be associated with central bronchiectasis. The vast majority of cases are diagnosed during this period.
Patients with stage V (fibrosis) often have extensive bronchiectasis, pulmonary fibrosis, pulmonary hypertension, fixed airflow obstruction, severe irreversible lung damage, etc., which may have chest tightness, shortness of breath, difficulty breathing, cyanosis, and respiratory failure. Visible clubbing. Serological examination of patients may have or lack of active performance and the prognosis is poor.
3: Allergic Bronchopulmonary Aspergillosis Test:
Serum total IgE is elevated. The threshold used to increase serum total IgE in current diagnostic criteria is generally 1000 IU/ml. If another threshold of 1000ug/L (equivalent to 417 IU/ml) is used, it may lead to excessive ABPA. Diagnosis, Aspergillus precipit antibody positive, serum-specific IgE and IgG antibodies were elevated. Peripheral blood eosinophils increase.
The non-specific image of ABPA is characterized by repetitive and migratory pulmonary infiltrates. 80% to 90% of patients have different degrees of pulmonary infiltration, and from whole lobes to large lobes, most of them appear in the course of the disease. Stages are not always associated with acute symptoms. Atypical pulmonary hyperinflation or decreased lung volume occurs in 30% to 40% of patients. ‘Allergic Bronchopulmonary Aspergillosis (ABPA) diagnosis criteria Treatment’
The specific imaging of ABPA is characterized by central bronchiectasis dominated by the above lobe. CT scan shows thickening of the bronchial wall, dilatation of the bronchial wall, double-track sign, and sign of the ring. The bronchus can be blocked by the sputum. , branch or toothpaste-like, refers to the set of shadows. ABPA mucus is a common caulking, and a certain X-ray characteristic signs, 37% to 65% of patients with X-ray evidence of mucus in the course of a certain time of caulking, the total over an STD nearly 1/3 change. Typical performance for 2 ~ 3cm long, 5 ~ 8mm linear or strip-shaped finger diverging from the shadow of the opaque to the ground-glass opacities, and sputum caused by atelectasis, etc., can occur late lung Swelling and fibrosis. Imaging changes are more common in the upper lobe, which is 2 to 3 times lower than the lower lobe.
Pulmonary dysfunction in patients with ABPA, including abnormalities in lung ventilation and gas exchange function, depends primarily on the extent of disease activity. Reversible obstructive ventilatory dysfunction is most common to some extent. Pulmonary fibrosis in patients with chronic ABPA may present with restrictive ventilatory dysfunction, diffusion disorders, and fixed airflow limitation. Studies have shown that ABPA reversible airway obstruction with a decrease in diffusion is parallel to lung volume reduction. As the disease progresses, irreversible airway obstruction and varying degrees of pulmonary fibrosis often occur, and lung function damage is further aggravated.
4: Allergic Bronchopulmonary Aspergillosis Diagnosis:
1.ABPA initial diagnosis according to the diagnostic criteria of Rosenberg Patterson include
i: Main criteria 1 bronchial asthma; 2 presence or previous pulmonary infiltration; 3 central bronchiectasis ; 4 peripheral blood eosinophilia (1000/mm 3 ); 5 Aspergillus fumigatus allergens rapid Negative skin test; 6 Aspergillus fumigatus allergen precipitation antibody positive; 7 serum anti-Aspergillus specific IgE, IgG antibody increased; 8 serum total IgE concentration increased (> 1000ug / l).
ii: Secondary diagnostic criteria include more than one sputum smear or Aspergillus culture positive; 2 coughs brown sputum; 3 Aspergillus allergen delayed skin reaction positive.
2. In 1997, Greenberger proposed the minimum diagnostic criteria for ABPA.
1 asthma; 2 skin test Aspergillus antigen positive reaction; 3 serum total IgE increased; 4 serum anti-Aspergillus fumigatus IgE increased and/or IgG levels increased; 5 current or previous lung infiltration diagnosis of ABPA-S; The combined central bronchiectasis was diagnosed as ABPA-CB.
3. Diagnosis of ABPA in the guidelines for the diagnosis and treatment of aspergillosis developed by the American Society of Infection in 2008.
i: There are 7 main criteria 1 bronchial obstructive symptoms (asthma); 2 peripheral blood eosinophilia; 3 Aspergillus allergens rapid skin test positive; 4 serum Aspergillus allergen precipitation antibody positive; 5 serum total IgE concentration increased; 6 pulmonary imaging examination or previous pulmonary infiltration; 7 central bronchodilation.
ii: Secondary diagnostic criteria include 1 smear and/or repeated finding of Aspergillus in culture; 2 histories of coughing out brown mucus plug or patch; 3 increase in serum Aspergillus-specific IgE antibody; 4 late onsets of Aspergillus allergen Sexual skin test was positive.
5: Allergic Bronchopulmonary Aspergillosis Diagnosis Criteria:
It needs to be differentiated from asthma, chronic eosinophilic pneumonia, Churg-Strauss syndrome, and tuberculosis. In the presence of pulmonary infiltration in ABPA, peripheral blood eosinophilia and total IgE (mean 2000 to 14000 ng/ml) were quite significant and can be clearly distinguished from patients with Aspergillus skin test positive asthma.
6: Allergic Bronchopulmonary Aspergillosis Treatment:
Glucocorticoid therapy can alleviate and eliminate symptoms of an acute exacerbation and prevent permanent damage such as bronchiectasis, irreversible airway obstruction, and pulmonary fibrosis. “Allergic Bronchopulmonary Aspergillosis (ABPA) diagnosis criteria Treatment” Prednisone is recommended and the dose is based on clinical symptoms, X-ray findings, and total IgE levels.