ABSTRACT
The management of ABPA depends on the extent and stage of the disease. Underlying asthma should be controlled with environmental changes, pharmaco- and immunotherapy. Baseline examinations and evaluations of pulmonary function, airway and parenchymal anatomy, and serum total IgE levels are important and should be re-evaluated based on the clinical course of the patient. The mainstay of pharmacotherapy for ABPA remains oral corticosteroids. The dose and duration of treatment in the initial stage of the disease depends on when it was diagnosed as well as the patient's clinical course. Anti-fungal agents should be considered as adjunctive. Clinical data suggests that the early institution of treatment is likely to prevent progression of ABPA to end-stage fibrosis.
Subject(s)
Administration, Oral , Adrenal Cortex Hormones/administration & dosage , Aspergillosis, Allergic Bronchopulmonary/drug therapy , Asthma , Humans , Hypersensitivity , Immunoglobulin E/blood , Prognosis , Pulmonary Fibrosis/etiology , Severity of Illness IndexABSTRACT
Aspergillus fumigatus (Af) is ubiquitous saprophytic fungus associated with a broad spectrum of diseases in humans. These diseases range from benign colonization of the lung to life threatening diseases such as allergic bronchopulmonary aspergillosis (ABPA) and invasive aspergillosis. Af is the etiologic agent identified in most of the Aspergillus related human diseases and is therefore of particular clinical importance. Af induced obstructive airway diseases may be due to transient exposure to fungal spores resulting in a T helper 2 response. The IgE mediated inflammatory reaction could be due to colonization of bronchial airway epithelium by Af. Early and precise diagnosis of Aspergillus induced respiratory allergy is essential for preventing irreversible lung damages. The major problems in the diagnosis of A. fumigatus induced diseases are due to the lack of standardized and well characterized fungal extracts. The advent of molecular cloning technology and the development of phage surface display technology for cloning genes have facilitated the isolation of more relevant recombinant allergens. Using these techniques, a panel of different Af allergens having distinct IgE binding with various groups of Af sensitized patients have been cloned and characterized. These allergens can be categorized functionally as secreted and cytoplasmic proteins. The distinct IgE binding property of these purified and well characterized recombinant Af allergens may be useful for the differential diagnosis of Af related pulmonary complications.
Subject(s)
Allergens/genetics , Aspergillosis, Allergic Bronchopulmonary/immunology , Aspergillus fumigatus/immunology , Humans , Immunoglobulin E/blood , ImmunotherapyABSTRACT
Estudios de nuestras relacionadas a la cana de azucar y otras fuentes ambientales demuestran que los dos principales actinomicetos termofilicos aislados en las planicies de la costa Sur de Puerto Rico son Thermoactinomyces candidus y T.vulgaris. Muestras de aires tomadas al momento que hay quema de la cana demuestran la aislacion de un gran numero de actinomicetos termofilicos mientras que los resultados son negativos cuando no hay quema de la cana