To Determine the Previlance of Fungal Infection Among Patient with Sputum Negative Old Treated Pulmonary Tuberculosis

A descriptive study was conducted in the Department of Respiratory Medicine in a tertiary care center ofAmbala. Aim of the study was to determine the prevalence of fungal infection among patient presents withsputum negative old treated pulmonary tuberculosis. The study was carried out among 39 post treated casesof Pulmonary Tuberculosis, whose sputum or bronchial wash showed isolation of Aspergillus. Demographicdetails and clinical findings were noted. Data collected were entered into Excel spreadsheet and quantitativedata were expressed as number and percentage. The presentation of pulmonary aspergillosis in treated casesof pulmonary TB varies from aspergilloma (51.3%) to chronic necrotizing pulmonary aspergillosis (38.4%) toallergic bronchopulmonary aspergillosis (10.3%). Hemoptysis (79.5%) of varying severity was the mostcommon symptom. Most of the patients were farmers by occupation. The most common species wereAspergillus fumigatus; others were Aspergillus flavus, Aspergillus niger and Aspergillus terrus in 23.2%,20.5%, and 12.8 %, respectively. Here we conclude that Aspergillus fumigatus was the most frequentlyisolated species in our region and aspergilloma was the commonest pulmonary manifestation as post-TBsequel.

Empyema Thoracis A Rare Presentation Of Aspergillus Infection

Introduction:The involvement of pleura in patients with allergic bronchopulmonary aspergillosis (ABPA) is uncommon.Aspergillus species is one of the most common causes of fungal infection of the lungs. Aspergillus empyema is a rare clinical entity and not included in classification of aspergillus related lung disease.Case Report : A29 year old female patient with history of bronchial asthma, presented with fever, dry cough and right sided chest pain. On auscultation, the breath sounds were diminished in intensity over the right infrascapular area and diffuse wheeze was heard in the rest of the lung fields. Achest radiograph confirmed the presence of a right sided pleural effusion.On thoracocentesis, thick fluid was drained which was found to be exudative. She demonstrated immediate cutaneous hypersensitivity to Aspergillus fumigatus antigen.Both total Immunoglobulin E and A. fumigatus specific antibody were elevatedpatient was started on voriconazole and prednisolone. Patient started to clinically improve and radiological resolution started after 10 days.CONCLUSION:Tubercular Empyemas are a common presentation in Indian setting but empyema of fungal origin are rare. Hence a high index of suspicion is required to ensure timely diagnosis and treatment of this potentially lethal condition. Aspergillus is a rare cause of pleural effusion and must be thoroughly evaluated in patients with a history of asthma/ABPA

Prevalence of allergic bronchopulmonary aspergillosis among patients with severe bronchial asthma in a tertiary care hospital in Northern India

Introduction: The link between fungi and asthma has been known for centuries. About one-third to one-half of severe asthmatics has history of atopic sensitization to filamentous fungi, most predominantly to Aspergillus fumigatus. Allergic bronchopulmonary aspergillosis (ABPA) is the one of the most documented fungal presentations among patients with asthma. This study was done on 50 patients with severe asthma who were consecutively enrolled from January 2016 to June 2017 to look for prevalence of ABPA. Materials and Methods: Blood samples were collected from 50 patients with severe asthma, and serum was separated to test for absolute eosinophil count, total IgE, and Aspergillus fumigates–specific IgE. Results: The prevalence of ABPA was found to be 70% (35/50). Of these, ABPA-B (ABPA with bronchiectasis) was less 31.4% (11/35) when compared with 68.5% (24/35) of patients with serological ABPA. Out of these 35 patients, there were 18 females and 17 were males. The mean age of the patients was 41.3 years. Conclusion: ABPA prevalence is high in patients with severe asthma, and there is a need to look for and evaluate this association further.

Exames para avaliar a sensibilização ao aspergillus fumigatus em fibrose cística / Tests to assess sensitization to aspergillus fumigatus in cystic fibrosis

RESUMO Objetivo: Avaliar os resultados dos exames utilizados para identificar a sensibilização IgE-mediada ao Aspergillus fumigatus em pacientes com fibrose cística. Métodos: Estudo transversal descritivo com amostra de conveniência de 86 pacientes com fibrose cística, acompanhados em Serviço de Referência de Fibrose Cística de hospital universitário terciário. Realizaram-se exames para avaliar sensibilização ao A. fumigatus em pacientes com fibrose cística: IgE sérica total, contagem de eosinófilos sanguíneos, identificação do fungo por swab de orofaringe ou por cultura de escarro, IgE sérica específica e testes cutâneos de hipersensibilidade imediata. Foram comparados os resultados dos diferentes exames realizados. Resultados: Em 33 (38,4%) pacientes com fibrose cística, com faixa etária de 1 a 33 anos (mediana de 8 anos), os resultados dos exames sobre sensibilização IgE mediada ao A. fumigatus foram: em 16 pacientes, aumento de IgE sérica específica (>0,35 kU/L); em 23, positividade aos testes cutâneos; e seis mostraram sensibilização a partir dos dois exames. Foram observados dois pacientes com eosinofilia (>1.000 eosinófilos/mm3) e sete com aumento de IgE sérica total (>1.000 UI/mL), sem que esses apresentassem positividade aos testes cutâneos ou aumento de IgE específica ao A. fumigatus. Em nenhum paciente foi isolado A. fumigatus no swab de orofaringe e/ou na cultura de escarro. Conclusões: Concluímos que, entre os exames para avaliar a sensibilização ao A. fumigatus na fibrose cística, são necessários os teste cutâneos de hipersensibilidade imediata e a dosagem de IgE sérica específica ao A. fumigatus. A eosinofilia sérica e a cultura de secreções respiratórias não foram essenciais neste estudo.

ABSTRACT Objective: To evaluate the results of the tests used to identify the IgE mediated sensitization to Aspergillus fumigatus in patients with cystic fibrosis. Methods: This is a cross-sectional descriptive study with a convenience sample of 86 patients diagnosed with cystic fibrosis in the Reference Service in Cystic Fibrosis at a tertiary teaching hospital. The following tests were performed to assess the sensitization to A. fumigatus in patients with cystic fibrosis: Total serum IgE, eosinophil count, fungus detection through oropharyngeal swab or sputum culture, serum-specific IgE, and immediate-type hypersensitivity (IgE) skin tests. We compared the results of the different tests performed. Results: In 33 (38.4%) patients with cystic fibrosis, with ages ranging from 1 to 33 years (median of 8 years), the IgE-mediated A. fumigatus sensitization test results were: in 16 patients, there was an increase in serum-specific IgE (>0.35 kU/L); in 23, skin tests were positive; and six had sensitization in both tests. We observed two patients with eosinophilia (>1,000 eosinophils/mm3) and seven with increasing total serum IgE (>1,000 IU/mL), all of whom obtained negative results in skin tests and had no IgE increase specific to A. fumigatus. A. fumigatus was not detected in oropharyngeal swabs and/or sputum culture of any patients. Conclusions: We conclude that, among the tests used to assess sensitization to A. fumigatus in cystic fibrosis patients, both serum-specific IgE and immediate-type hypersensitivity (IgE) skin tests are required. Serum eosinophilia and respiratory secretion culture were not essential in this study.

Murine models of Aspergillosis: Role of collectins in host defense.

Aspergillus fumigatus, a ubiquitous fungus, causes a wide spectrum of clinical conditions ranging from allergic to invasive aspergillosis depending upon the hosts’ immune status. Several animal models have been generated to mimic the human clinical conditions in allergic and invasive aspergillosis. The onset, duration and severity of the disease developed in models varied depending on the animal strain/fungal isolate, quantity and mode of administration of fungal antigens/spores, duration of the treatment, and type of immunosuppressive agent used. These models provide insight into host and pathogen factors and prove to be useful for evaluation of diagnostic markers and effective therapies. A series of studies established the protective role of collectins in murine models of Allergic Bronchopulmonary Aspergillosis and Invasive Pulmonary Aspergillosis. Collectins, namely surfactant protein A (SP-A), surfactant protein D (SP-D) and mannan binding lectin (MBL), are pattern recognition molecules regulating both innate and adaptive immune response against pathogens. In the present review, we discussed various murine models of allergic and invasive aspergillosis and the role of collectins in host defense against aspergillosis.

Allergic Bronchopulmonary Aspergillosis: An Occult Disease Waiting To Be Explored- Case Report And Review Of Literature.

Allergic bronchopulmonary aspergillosis (ABPA) is a slowly progressive disease caused by hypersensitivity to Aspergillus fumigatus. This condition is most commonly seen in patients with asthma and cystic fibrosis. ABPA mimics a wide range of diseases, thereby further accentuating the difficulties faced by medical practitioners in diagnosing this condition. Even today, this condition remains under diagnosed in many countries with reports of mean diagnostic latency of ten years between the occurrence of symptoms and the diagnosis. We present a case report and review of literature with the aim of highlighting the complicated nature of this enigmatic illness.

Aspergilosis broncopulmonar alérgica en pediatría / Allergic bronchopulmonary aspergillosis in childhood

La aspergilosis broncopulmonar alérgica (ABPA) es una complicación importante en niños portadores de asma atópica, fibrosis quística (FQ) y otras enfermedades pulmonares crónicas asociadas a bronquiectasias. Esta afección es el resultado de la colonización de la vía aérea por Aspergilus, habitualmente fumigatus, produce una reacción de hipersensibilidad tipo Th2CD4 con la producción de IgE total y específica. El diagnóstico debe sospecharse en pacientes que presenten secreciones bronquiales en moldes café, aparición o aumento de sibilancias, infiltrados pulmonares y reducción de la función pulmonar. Si esta afección no es tratada precozmente puede conducir a un severo deterioro de la función pulmonar y a largo plazo llegar a la fibrosis. El diagnóstico es difícil debido a la sobreposición de las manifestaciones clínicas y radiológicas de la ABPA con exacerbaciones pulmonares producidas por bacterias o virus. Se han sugerido criterios para establecer el diagnóstico; en este sentido la IgE total y específica son los más importantes. Últimamente han sido desarrollados nuevos test serológicos con el objeto de mejorar la detección precoz y monitorización de la ABPA, presentando gran sensibilidad y especificidad. El tratamiento consiste en el uso de corticoides sistémicos. El itraconazol parece mejorar el control de la enfermedad y reducir la dosis de corticoides.

Fungal infections of lungs the emerging scenario.

Fungal infections of lungs are important infective processes which are being encountered more and more often in today’s practice. Fortunately, we only encounter a few of these pathogenic fungi. With more and more people undergoing organ transplantation and cytotoxic therapy, chances of encountering these diseases are steadily increasing. Though treatment is difficult, nevertheless, the results are encouraging. Hence, it is all the more important today to know these diseases well so that we are able to manage them scientifically. Diseases like ABPA, if diagnosed early, can be treated effectively so as to prevent progression to fibrotic stage and reduce the number of respiratory cripples. Invasive systemic mycosis is also amenable to multimodal therapy. With advent of newer imidazoles and newer modalities of drug delivery like liposomal amphotericin B, the so called complicated treatment modalities can be further simplified. Prophylaxis is today available for preventing PCP in immunocompromised patients and they need to adhere to prophylaxis.

Allergic bronchopulmonary aspergillosis associated with aspergilloma / 대한내과학회지

Aspergilloma and Allergic Bronchopulmonary Aspergillosis (ABPA) are different types of spectrum of pulmonary aspergillosis. ABPA results from hypersensitivity reaction to Aspergillus species and is known to be usually associated with bronchial asthma and cystic fibrosis. Aspergilloma results from simple colonization of this fungus within cavitary lung lesion or bronchiectasis. But rarely some patients can present together with ABPA and aspergilloma. We experienced a case of ABPA associated with aspergilloma in a 38 year-old male. The diagnosis was confirmed by asthma, immediate cutaneous reactivity to A. fumigatus, IgG antibody to A. fumigatus, elevated total and specific IgE antibodies to A. fumigatus, central bronchiectasis and peripheral eosinophilia coincident with radiographic infiltrates. During follow-up management with steroid, left pneumonectomy was done because of spontaneous pneumothorax with persistent air-leak and multidrug resistance pulmonary tuberculosis in association with aspergilloma. His respiratory symptoms and ABPA activity was much more improved after removal of aspergilloma. These findings suggest that surgical resection of aspergilloma can be considered to reduce antigenic source of colonized fungi in ABPA patients when associated with aspergilloma.

Pulmonary Aspergillosis / 대한의진균학회지

Aspergillus is a ubiquitous fungus which is found in soil, composed piles, and even in the air. It causes various clinical syndromes, which are mainly determined by the immunocompetence of host; simple colonization in normal person, aspergilloma in patients with lung cavities (e.g. after tuberculosis), chronic necrotizing pneumonia in mildly immunocompromised hosts (e.g. DM or alcoholics) or those who have chronic lung diseases, invasive aspergillosis which is severe and commonly fatal in immunocompromised patients. It may cause hypersensitivity reaction; IgE-mediated asthma, hypersensitivity pneumonitis (extrinsic allergic alveolitis), allergic Aspergillus sinusitis, allergic bronchopulmonary aspergillosis (ABPA). It is essential for clinicians to be familiar with the spectrum of Aspergillus-related clinical syndromes. After a brief review of each clinical syndrome, ABPA that is a typical allergic disease was reviewed in detail.

A case of allergic bronchopulmonary aspergillosis (ABPA) occurring in a bullae of the lung / 천식및알레르기

Allergic bronchopulmonary aspergillosis(ABPA) is a syndrome seen in patients with asthma and cystic fibrosis. It is characterized by chronic cololinization of the airways with a ubiquitous fungus, Aspergillus fumigatus. Clinically, it is a syndrome characterized by recurrent episodes of wheezing, mucus production, pulmonary infiltrates, and elevated levels of serum IgE. ABPA patients are also accompanied with bronchiectasis in 89% and observed in 10% of cystic fibrosis that show the features of end-stage lung pattern. There are few reports of ABPA associated with bullae. We will report here a case of ABPA developing in an old cicartrical and bullous lesion of a lung.

A Case of Allergic Bronchopulmonary Aspergillosis / 소아알레르기및호흡기학회지

Aspergillosis is a systemic fungal infection caused by Aspergilli, mainly, Aspergillus fumigatus. The pulmonary aspergillosis is a group of three separate disease, comprising invasive aspergillosis, aspergilloma, and allergic bronchopulmonary aspergillosis (ABPA), or a disease process in which one of three entities overlap with another process. ABPA is a chracterized clinically by asthma, blood and sputum eosinophilia and recurrent pulmonary infiltrations or mucoid impaction, which pathogenesis seems to be hypersensitivity reaction to Aspergillus fumigatus (Af). Recently we experienced a case of ABPA, one of three clinical manifestations of pulmonary aspergillosis. He had asthma as an infant, but had no asthmatic symptoms on admission, and there was no evidence of fungal infection at blood culture and routine bacterial culture with sputum. But, diagnosis was confirmed by test for immediate skin reaction to Af was positive, skin prick test and Greenburg and Petterson's criteria. After steroid treatment, he became asymptomatic. We report this case with brief review of literature.