A Clinico-Serological Correlation with Radiologic Profile of Allergic Bronchopulmonary Aspergillosis (ABPA)

Abstract

Background: Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory condition induced by immune responses to Aspergillus fumigatus, which colonizes the airways of people with asthma and cystic fibrosis. The most prevalent signs are treatment-resistant asthma, transitory and fleeting pulmonary opacities, and bronchiectasis.
Objective: To assess clinical, immunological, and radiology features of allergic bronchopulmonary aspergillosis (ABPA).
Materials and Methods: The International Society for Human and Animal Mycology (ISHAM) criteria was applied. Patients in which Serum IgE levels >500 IU/ml, investigated for ABPA and classified as ABPA-S, ABPA-CB, ABPA-CB-HAM, ABPA-CB-ORF based on the high-resolution CT findings.
Results: Mean AEC was 1082.19 cells/µL, Mean S.IgE level was 7466.91 IU/ml (range: 51.43-446331 IU/mL). Mean Asp. S. IgE was 19.86 kUA/L and Asp. S. IgG was 59.55 mgA/L. ABPA-CB was most common (55.33%), followed by ABPA-HAM (25.33%) and ABPA-S (19.33%). Significant association was seen between S.IgE (IU/mL) and CT features (p-value = 0.015). Significant association was seen between ASP. S.IgE (IU/mL) and CT features - Central bronchiectasis (p-value = 0.006).
Conclusion: Asthmatic patients presenting to chest clinics should be routinely screened for ABPA with Total IgE Levels and A. fumigatus specific IgE levels. It is imperative that the diagnosis of ABPA is carried out as early as possible, as untreated disease usually culminates in bronchiectasis and pulmonary fibrosis, all manifestations of end-stage lung disease.