Diagnosis and treatment of allergic bronchopulmonary aspergillosis

Tanner, Nichole T.; Judson, Marc A.

doi:10.1007/s12281-008-0029-8

Cited by 2 publications

(5 citation statements)

References 42 publications

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“…Clinical manifestations of ABPA include wheezing and bronchospasms and for individuals with CF, decline in lung function may occur [ 27 ]. For non-CF patients, ABPA diagnostic criteria include asthma, elevated serum levels of Aspergillus -specific IgG antibodies, elevated serum levels of IgE and eosinophilia [ 28 , 29 ]. Several of the diagnostic criteria for ABPA are common manifestations of CF, for example, elevated IgG and IgE anti- A. fumigatus antibodies are not uncommon in CF serum due to sensitization to A. fumigatus in CF [ 30 ].…”

Section: Aspergillus Fumigatusmentioning

confidence: 99%

“…Several of the diagnostic criteria for ABPA are common manifestations of CF, for example, elevated IgG and IgE anti- A. fumigatus antibodies are not uncommon in CF serum due to sensitization to A. fumigatus in CF [ 30 ]. For this reason diagnosis of ABPA in a CF patient may present certain challenges [ 29 ]. Nonetheless, in the context of ABPA diagnosis, A. fumigatus -specific IgE levels are recognized as the most useful diagnostic tool [ 30 , 31 ].…”

Section: Aspergillus Fumigatusmentioning

confidence: 99%

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Bacterial Interactions with Aspergillus fumigatus in the Immunocompromised Lung

2021

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The immunocompromised airways are susceptible to infections caused by a range of pathogens which increases the opportunity for polymicrobial interactions to occur. Pseudomonas aeruginosa and Staphylococcus aureus are the predominant causes of pulmonary infection for individuals with respiratory disorders such as cystic fibrosis (CF). The spore-forming fungus Aspergillus fumigatus, is most frequently isolated with P. aeruginosa, and co-infection results in poor outcomes for patients. It is therefore clinically important to understand how these pathogens interact with each other and how such interactions may contribute to disease progression so that appropriate therapeutic strategies may be developed. Despite its persistence in the airways throughout the life of a patient, A. fumigatus rarely becomes the dominant pathogen. In vitro interaction studies have revealed remarkable insights into the molecular mechanisms that drive agonistic and antagonistic interactions that occur between A. fumigatus and pulmonary bacterial pathogens such as P. aeruginosa. Crucially, these studies demonstrate that although bacteria may predominate in a competitive environment, A. fumigatus has the capacity to persist and contribute to disease.

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Section: Aspergillus Fumigatusmentioning

confidence: 99%

Section: Aspergillus Fumigatusmentioning

confidence: 99%

Bacterial Interactions with Aspergillus fumigatus in the Immunocompromised Lung

2021

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“…Spores are easily inhaled (2 µm to 5 µm in diameter) through the carina; they settle in distal and terminal airways, where they germinate in hyphae, especially in favorable environments such as mucus. Hyphae are able to release proteases that are responsible for the degradation of the epithelial cell layer [11]. As a result, the diffusion of antigens is promoted through the bronchial epithelium.…”

Section: Pathogenesismentioning

confidence: 99%

“…Findings during physical examination are usually similar to asthma, revealing wheezing and a prolonged expiratory phase. Clubbing, pulmonary hypertension and cyanosis may be present at advanced stages of the disease [11].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Their anti-inflammatory action suppresses the immune hyper-reactivity of ABPA in both asthmatic and CF patients. Therapy with OCS leads to an improvement of symptoms and resolution of pulmonary infiltrates, and decreases total serum IgE levels and peripheral eosinophilia [11], but at considerable cost in terms of side effects, if chronically administered, such as gastric ulcers, osteoporosis, diabetes, and immune, adrenal and growth suppression.…”

Section: Systemic Glucocorticoid Therapymentioning

confidence: 99%

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Allergic Bronchopulmonary Aspergillosis: Diagnostic and Treatment Challenges

Leonardi¹,

Cinicola²

2016

J Pulm Respir Med

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Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder, occurring mostly in asthmatic and\ud cystic fibrosis patients, caused by an abnormal T-helper 2 lymphocyte response of the host to Aspergillus fumigatus\ud antigens. ABPA diagnosis is defined by clinical, laboratory and radiological criteria including active asthma, immediate\ud skin reactivity to A. fumigatus antigens, total serum IgE levels>1000 IU/mL, fleeting pulmonary parenchymal\ud opacities and central bronchiectases that represent an irreversible complication of ABPA. Despite advances in our\ud understanding of the role of the allergic response in the pathophysiology of ABPA, pathogenesis of the disease is still\ud not completely clear. In addition, the absence of consensus regarding its prevalence, diagnostic criteria and staging\ud limits the possibility of diagnosing the disease at early stages. This may delay the administration of a therapy that can\ud potentially prevent permanent lung damage. Long-term management is still poorly studied. Present primary therapies,\ud based on clinical experience, are not yet standardized. These consist in oral corticosteroids, which control acute\ud symptoms by mitigating the allergic inflammatory response, azoles and, more recently, anti-IgE antibodies. The latter\ud two are used as a steroid-sparing agent to prolong the remission stage of the disease. Anti-IgE antibodies also have\ud immunomodulatory properties. At present, the only way to bypass these limits and allow for an early diagnosis, is\ud to assume ABPA in all patients with difficult-to-control asthma or cystic fibrosis. They should then be screened for\ud sensitization to A. fumigatus antigens and, if positive, monitored more closely. Future controlled studies are needed\ud to standardize present therapy, standardize cut-off values of various investigations, define the role of different novel\ud immunomodulatory therapies, define the role of novel assays (such as recombinant A. fumigatus antigens and CCL17)\ud and confirm new diagnostic and staging criteria

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Diagnosis and treatment of allergic bronchopulmonary aspergillosis

Cited by 2 publications

References 42 publications

Bacterial Interactions with Aspergillus fumigatus in the Immunocompromised Lung

Bacterial Interactions with Aspergillus fumigatus in the Immunocompromised Lung

Allergic Bronchopulmonary Aspergillosis: Diagnostic and Treatment Challenges

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