Pulmonary aspergillosis - allergic bronchopulmonary type

Alternative names

Definition

Causes, incidence, and risk factors

The aspergillus fungus is common. It can grow on dead leaves, stored grain, bird droppings, compost stacks and other decaying vegetation. Although most people are frequently exposed to aspergillus, infections caused by it such as a pneumonia or fungus ball ( aspergilloma ) are rare.

Some people, however, have an allergic reaction (hypersensitivity) to this fungus, which is called allergic bronchopulmonary aspergillosis (ABPA). It is characterized by inflammation of the airways (bronchi) or air sacs (alveoli). The disease may mimic asthma or pneumonia, and, in fact, most patients with ABPA have asthma as well.

Patients with asthma or cystic fibrosis are at highest risk for allergic aspergillosis.

Symptoms

• worsening symptoms of asthma
• wheezing
• cough may produce brownish plugs or bloody sputum
• fever

Signs and tests

• elevated CBC eosinophil count
• elevated serum IgE antibodies: total IgE level and level of IgE specific for aspergillus
• aspergillus antigen skin test
• positive serum aspergillus antibodies
• chest X-ray showing infiltrates and finger-like shadows
• chest CAT scan showing central bronchiectasis (dilation of the airways) or mucous plugging
• sputum stain and culture for fungus
• bronchoscopy with cultures and transbronchial biopsy
• rarely lung biopsy is required

Treatment

Allergic aspergillosis is treated with oral prednisone. The anti-fungal antibiotic, itraconazole, can also be helpful. People with asthma should also continue their usual inhaler treatments.

Expectations (prognosis)

Complications

• irreversible airway obstruction
• bronchiectasis
• mucous plugging
• respiratory failure

Calling your health care provider

Prevention

Update Date: 7/17/2002