The Use of Bronchofiberscopy for Diagnosis of Allergic Bronchopulmonary Aspergillosis.

Tamura, Atsuhisa; Hebisawa, Akira; Kurashima, Atsuyuki; Kawabe, Yojiro; Machida, Kazuko; Yotsumoto, Hideki; Mori, Masaki

doi:10.2169/internalmedicine.36.865

Cited by 17 publications

(7 citation statements)

References 12 publications

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“…Therefore, the importance of mucous plugs for diagnosing ABPM should be reconsidered. Our study indicates that, with an aggressive investigation of mucous plugs, some patients can be diagnosed as having ABPM before serum immunological tests turn positive (33). However, typical pathological findings were detected in 17 of the 41 patients in the present study, which indicates that the use of other investigational methods is required.…”

Section: Discussioncontrasting

confidence: 52%

Clinical Characteristics of Biopsy-proven Allergic Bronchopulmonary Mycosis: Variety in Causative Fungi and Laboratory Findings

Ishiguro¹,

Takayanagi²,

Kagiyama³

et al. 2014

Intern. Med.

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Objective The diagnosis of allergic bronchopulmonary mycosis (ABPM) has traditionally relied widely on Rosenberg's criteria, which emphasize immunologic responses while overlooking the investigation of mucous plugs as a primary criterion. Therefore, the characteristics of biopsy-proven ABPM require further elucidation. The aim of this study was to analyze the clinical characteristics of biopsy-proven ABPM and address whether full compliance with clinical criteria, such as the presence of asthma, and certain laboratory findings is necessary to establish a diagnosis of ABPM. Methods We retrospectively analyzed 17 patients with biopsy-proven ABPM focusing on causative fungi and laboratory findings. Results Causative fungi included Aspergillus sp. in seven patients, Schizophyllum commune in four patients, Penicillium sp. in two patients and unknown in five patients. Bronchial asthma was observed in 10 patients, eosinophilia was observed in 10 patients and an increased serum immunoglobulin (Ig) E level was observed in 14 of the 17 patients. IgG for Aspergillus sp. was positive in six of the seven patients with ABPM due to Aspergillus and turned positive in the remaining patient during follow-up. Technological limitations prevented the measurement of specific IgE for S. commune and IgG for S. commune and Penicillium sp. in most patients. Computed tomography revealed central bronchiectasis, pulmonary infiltration and mucous plugs in all patients. Conclusion Causative fungi other than Aspergillus sp. are not uncommon, and immunological tests for other fungi should be popularized. Asthma and characteristic laboratory findings, such as peripheral blood eosinophilia, increased serum IgE and precipitating antibodies, may not always be required to diagnose ABPM. The importance of typical pathologic findings of mucous plugs for diagnosing ABPM requires reevaluation. Further studies are needed to establish more elaborate diagnostic criteria for ABPM.

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Section: Discussioncontrasting

confidence: 52%

Clinical Characteristics of Biopsy-proven Allergic Bronchopulmonary Mycosis: Variety in Causative Fungi and Laboratory Findings

Ishiguro¹,

Takayanagi²,

Kagiyama³

et al. 2014

Intern. Med.

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“…Bronchoscopy has been shown to have a role in the diagnosis of ABPA (72,73), especially in patients with atypical manifestations and those who do not meet the standard diagnostic criteria (see below). Bronchoscopic examination in these two studies (72,73) revealed evidence of mucous plugging.…”

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confidence: 99%

Aspergillus‐Related Lung Disease

Al-Alawi

Ryan

Flint

et al. 2005

Canadian Respiratory Journal

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Aspergillus is a ubiquitous dimorphic fungus that causes a variety of human diseases ranging in severity from trivial to life-threatening, depending on the host response. An intact host defence is important to prevent disease, but individuals with pre-existing structural lung disease, atopy, occupational exposure or impaired immunity are susceptible. Three distinctive patterns of aspergillus-related lung disease are recognized: saprophytic infestation of airways, cavities and necrotic tissue; allergic disease including extrinsic allergic alveolitis, asthma, allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis and chronic eosinophilic pneumonia; and airway and tissue invasive disease -- pseudomembranous tracheobronchitis, acute bronchopneumonia, angioinvasive aspergillosis, chronic necrotizing aspergillosis and invasive pleural disease. A broad knowledge of these clinical presentations and a high index of suspicion are required to ensure timely diagnosis and treatment of the potentially lethal manifestations of aspergillus-related pulmonary disease. In the present report, the clinical, radiographic and pathological aspects of the various aspergillus-related lung diseases are briefly reviewed.

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“…Bronchoscopy and BALF are helpful for the diagnosis and evaluation of patients with eosinophilic lung diseases, especially those with atypical manifestations[ 9 , 10 ]. In healthy individuals, the eosinophil percentage in BALF is < 1%.…”

Section: Discussionmentioning

confidence: 99%

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report

Wang¹,

Wan²,

Zheng³

et al. 2021

WJCC

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BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis (ABPA). As ABPA is an allergic respiratory disease, immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators. However, eosinophilia in bronchoalveolar lavage fluid (BALF) has not been considered in the diagnostic criteria for ABPA. CASE SUMMARY We present a case of ABPA in which the eosinophil count in peripheral blood was not increased, whereas the eosinophil percentage in BALF reached 60%. After antifungal and hormone therapy, imaging revealed very good resolution of lung infiltration. CONCLUSION The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention, especially when the patient’s clinical features lack specificity and the diagnostic parameters are negative.

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The Use of Bronchofiberscopy for Diagnosis of Allergic Bronchopulmonary Aspergillosis.

Cited by 17 publications

References 12 publications

Clinical Characteristics of Biopsy-proven Allergic Bronchopulmonary Mycosis: Variety in Causative Fungi and Laboratory Findings

Clinical Characteristics of Biopsy-proven Allergic Bronchopulmonary Mycosis: Variety in Causative Fungi and Laboratory Findings

Aspergillus‐Related Lung Disease

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report

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