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In medicine, allergic bronchopulmonary aspergillosis (ABPA) is a condition characterised by an exaggerated response of the immune system (a hypersensitivity response) to the fungus Aspergillus (most commonly Aspergillus fumigatus). It occurs most often in patients with asthma or cystic fibrosis. Aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals. A. fumigatus is responsible for a spectrum of lung diseases known as aspergilloses.
ABPA causes airway inflammation which can ultimately be complicated by sacs of the airways (bronchiectasis). The disease may cause airway constriction (bronchospasm). Besides asthma and cystic fibrosis, ABPA can also resemble other conditions such as eosinophilic pneumonia.
The exact criteria for the diagnosis of ABPA are not agreed upon. Chest X-rays and CT scans, raised blood levels of IgE and eosinophils, immunological tests for Aspergillus together with sputum staining and sputum cultures can be useful. Biopsies are rarely needed. Treatment consists of corticosteroids and antifungal medications.
Patients with allergic bronchopulmonary aspergillosis often have symptoms of poorly controlled asthma, with wheezing, cough, shortness of breath and exercise intolerance. They also have symptoms reminding of bronchiectasis, such as chronic sputum production, coughing up brownish mucoid plugs or even blood (the latter is called hemoptysis), and recurrent infections (with fever and malaise). However, since the infiltrates in ABPA indicate eosinophilic pneumonia, they do not respond to treatment with antibiotics. There may be unexplained worsening of asthma or cystic fibrosis.
A full blood count usually reveals eosinophilia more than 10% and there is a raised serum IgE more than 1000ng/ml.
Chest radiography shows various transient abnormalities:
Aspergillus specific tests[1]:
Fungal hyphae may be seen in the sputum.
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