ABSTRACT
Introducción: La aspergilosis broncopulmonar alérgica (ABPA) es infrecuente en pediatría, sin embargo, es necesario tener presente el diagnóstico e instaurar un tratamiento precoz, con la finalidad de evitar mayor deterioro de la función pulmonar. Objetivo: presentar nuestra experiencia en el diagnóstico y manejo de la ABPA en niños portadores de enfermedad pulmonar crónica (EPC) postviral y fibrosis quística (FQ). Pacientes y Método: 6 pacientes con ABPA diagnosticados entre los años 2000-2003, de 9 a 17 años de edad (promedio 13 años), 4 de sexo masculino y 2 femenino. El estudio se realizó en pacientes con EPC postviral o FQ que presentaban un cuadro clínico sugerente y se confirmó con dos o más cultivos positivos para Aspergillus sp, con la presencia de hifas y al menos un criterio primario. Resultados: La totalidad de los pacientes presentaron IgG específica elevada, 5 con test cutáneo positivo y eosinofilia. Los 6 niños mostraron nuevos infiltrados pulmonares y en 2 bronquiectasias centrales. Fueron tratados con prednisona 2 mg/kg/d durante un mes, luego igual dosis en días alternos por 4 meses e itraconazol 2-5 mg/kg/d durante 5 meses. Evolucionaron con mejoría clínica, de la saturometría y flujometría, y en 4 pacientes la espirometría. Todos disminuyeron los infiltrados pulmonares, negativizaron los cultivos y la IgG específica. No observamos efectos adversos con el tratamiento empleado. Conclusión: En pediatría la ABPA es poco frecuente, sin embargo, empeora la función pulmonar, por lo que debe ser considerada en niños portadores de asma bronquial, EPC o FQ. Nuestros pacientes se beneficiaron con el tratamiento utilizado.
Subject(s)
Humans , Male , Female , Child , Adolescent , Aspergillosis, Allergic Bronchopulmonary/complications , Aspergillosis, Allergic Bronchopulmonary/diagnosis , Aspergillosis, Allergic Bronchopulmonary/drug therapy , Aspergillus/isolation & purification , Aspergillosis, Allergic Bronchopulmonary/blood , Pulmonary Disease, Chronic Obstructive/complications , Follow-Up Studies , Cystic Fibrosis/complications , Hyphae/isolation & purification , Immunoglobulin G/blood , Itraconazole/therapeutic use , Prospective Studies , Prednisone/therapeutic useABSTRACT
Definitive diagnosis of pulmonary aspergillosis is difficult to establish. Thus, confirmative evidence of active fungal aggression is imperative. In this study, an immunodiffusion test was carried out on 36 cases of pulmonary aspergillosis and two groups of subjects comprising 133 patients with non-fungal diseases and 134 healthy volunteers as controls. The test was positive in 92.3% of the patients with mycetoma, in 50% of the patients with allergic bronchopulmonary aspergillosis, and in 25% of the patients with invasive aspergillosis. Results were negative in all subjects in the two control groups. The findings indicate the efficacy of the test under study for supporting the diagnosis of pulmonary aspergillosis.
Subject(s)
Adult , Aged , Aged, 80 and over , Aspergillosis/blood , Aspergillosis, Allergic Bronchopulmonary/blood , Female , Humans , Immunodiffusion , Lung Diseases, Fungal/blood , Male , Middle Aged , Precipitins/bloodABSTRACT
Allergic bronchopulmonary aspergillosis patients (ten in the age group 5-13) were studied with respect to clinical and immunodiagnostic tests. All the patients showed wheal and flare reaction with A. fumigatus antigens. Clinical features included bilateral infiltration and hilar lymphadenopathy. Eosinophilic count in these patients was observed to be in the range of 300-2500/mm3. Sera of six patients indicated precipitin reaction with A. fumigatus antigens. An elevated total serum IgE was noticed in all the patients. A. fumigatus specific IgG and IgE antibodies were increased in these patients. Optical density of the sera of all the patients against controls were observed to be in the range of (0.426 to 1.8 for IgG and 0.147 to 0.562 for IgE) by ELISA. Western blot analysis indicated that there may be correlation between the clinical stages of the disease and immunological reactivity of the sera with various antigenic components.