Clinical, Microbiological, Serological and Radiological Profile of Patients With Mild-Moderate and Severe Allergic Bronchopulmonary Aspergillosis (ABPA)

Amardeep Singh; Umma Sadia Tomo; Manoj Kumar Dodiya; Pankaj K Singh; Abdul Manan; Inimerla Bhavya; Varsha S Kumar; Irfan A Mir

doi:10.7759/cureus.44662

Clinical, Microbiological, Serological and Radiological Profile of Patients With Mild-Moderate and Severe Allergic Bronchopulmonary Aspergillosis (ABPA)

Cureus. 2023 Sep 4;15(9):e44662. doi: 10.7759/cureus.44662. eCollection 2023 Sep.

Authors

Amardeep Singh¹, Umma Sadia Tomo², Manoj Kumar Dodiya³, Pankaj K Singh⁴, Abdul Manan⁵, Inimerla Bhavya⁶, Varsha S Kumar⁷, Irfan A Mir⁸

Affiliations

¹ Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND.
² Internal Medicine, Rangpur Community Medical College, Rangpur, BGD.
³ Internal Medicine, Gujarat Cancer Society (GCS) Medical College & Research Institute, Ahmedabad, IND.
⁴ Emergency Medicine, School of Medical Sciences & Research, Greater Noida, IND.
⁵ Nephrology, New Cross Hospital, Wolverhampton, GBR.
⁶ Internal Medicine, School of Medical Sciences & Research, Greater Noida, IND.
⁷ Internal Medicine, Sapthagiri Institute of Medical Sciences & Research, Bengaluru, IND.
⁸ Internal Medicine, New Cross Hospital, Wolverhampton, GBR.

Abstract

Objective Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus antigen mostly Aspergillus fumigatus that occurs almost exclusively in patients with asthma and cystic fibrosis. ABPA is an underdiagnosed and undertreated disease because of its presentation with various grades of severity in asthma patients. Data available regarding the clinical, serological, and radiological profile of ABPA patients is limited due to lack of consensus on diagnostic criteria and treatment guidelines. Thus ABPA is a significant disease, especially in the Indian population where the incidence of allergic diseases like asthma is on the rise. Methods This prospective study was conducted in the Department of Pulmonary Medicine at one of the tertiary centers of north India. All consecutive patients diagnosed with allergic bronchopulmonary aspergillosis (ABPA) from 1st January 2017 to 30th September 2017 were included in the study. A total of 67 consecutive patients diagnosed with bronchial asthma were included in the study. The diagnosis of ABPA was based upon either criterion given by Rosenberg and Patersonor the International Society of Human and Animal Mycology (ISHAM) criteria. Patients diagnosed with ABPA were finally divided into mild, moderate, and severe. Results The majority of patients showed an obstructive pattern on spirometry and moderate to severe obstruction was the most common pattern observed among patients who had an obstructive pattern on spirometry. Also, all three patients with the mixed pattern on spirometry had severe disease. Serological analysis revealed that patients in the moderate category had a higher level of absolute eosinophil count (AEC), total IgE, and Aspergillus-specific IgE antibodies, especially in patients who had either high attenuation mucus (HAM) or centrilobular nodules on their high-resolution computed tomography (HRCT) scan. Conclusion ABPA is a disease of divergent presentation. We concluded to have alternate or add-on criteria for the classification of ABPA which was not based on the sequelae of chronic inflammatory changes in the lungs.

Keywords: allergic bronchopulmonary aspergillosis; centrilobular nodule; high attenuation mucus; ige; spirometry.