Allergic bronchopulmonary aspergillosis and Candida albicans colonization of the respiratory tract in corticosteroid-dependent asthma.

Fungal studies were conducted on 35 patients with corticosteroid-dependent asthma (CSDA) and 20 asthmatics who had never received prednisolone. Candida albicans was repeatedly cultured from the sputa of 12 patients with CSDA. Isolation was more frequent in those patients who were receiving more than 10 mg prednisolone for more than six months. Nearly half of these patients demonstrated a positive immediate cutaneous reaction and precipitating antibodies against C. albicans. Although no pathological significance, beside colonization, could be attributed to this finding, it was felt that it would be prudent to restrict the daily dose of prednisolone to less than 10 mg, when administered for more than six moths. Two patients with allergic bronchopulmonary aspergillosis (ABPA), were identified, one from each group. The possibility of ABPA, however, remained open in two other patients with CSDA. It is probable that some patients with CSDA may be suffering from ABPA but characteristic features of the disease are masked by costicosteroid therapy, making it difficult to diagnose.

Fibrebronchoscopy in pulmonary sarcoidosis--an Indian experience.

Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopathological support for the diagnosis was ultimately obtained in 20 patients. Fibrebronchoscopy provided the diagnosis in 17 patients, while histopathological confirmation was obtained from extrapulmonary biopsy sites in 3 patients. Transbronchial lung biopsy, attempted without fluoroscopic guidance, revealed non-caseating granulomata in 15 patients. The only complication encountered was a small pneumothorax, not requiring intervention, in one patient. Lack of fluoroscopic guidance did not compromise the diagnostic yield or increase the complication rate of the procedure. Bronchial biopsy confirmed the diagnosis in 2 patients with a non-specific lung biopsy. It was positive in 6 of 8 patients with an abnormal appearing mucosa and in 5 of 12 patients with a normal bronchial tree. Random bronchial biopsy in all patients, irrespective of mucosal changes, made an important contribution to the yield of fibrebronchoscopy. Fibrebronchoscopy confirmed the diagnosis of tuberculosis in 2 patients with an atypical radiological picture, thereby differentiating the two conditions which occasionally mimic each other.