Allergic bronchopulmonary aspergillosis: a clinico-serological correlation with radiologic profile

Abstract

Objective: To study the different types of radiological presentations of ABPA in a tertiary clinic in Northern India and analyze them with respect to serological profile and clinical characteristics. Methods: We performed a retrospective analysis of clinical, serological and radiological characteristics of ABPA patients registered at a unit of tertiary pulmonary care center in North India. The patients were classified based on radiological presentation into ABPA-S, ABPA-CB and ABPA-CB-ORF and the differences in these groups were studied. Results: There were 112 patients with ABPA between age 6 and 75 years. About 8.9% (n = 10) of patients had a history of smoking and 38.4% (n = 43) had a history of prior anti-tuberculosis treatment. The median duration of symptoms was longest in the ABPA-CB-ORF group (15 years) followed by ABPA-CB (7 years) and ABPA-S (5 years). Mean serum total IgE level in the ABPA-CB-ORF group was 14 330 IU/mL followed by the APBA-CB (3700 IU/mL) and ABPA-S (1020 IU/mL) groups (p < 0.0001). The ABPA-CB-ORF group had the highest median specific anti-Aspergillus fumigatus IgE followed by ABPA-CB and ABPA-S groups (42.24 kU/L, 20.65 kU/L and 3.44 kU/L, respectively) (p < 0.0001). ABPA-CB-ORF group had the highest percentage of positive serum precipitins against Aspergillus spp. (92%) followed by ABPA-CB (79.6%) and ABPA-S (68%) (p < 0.05). Conclusions: The patients with more pronounced lung damage in the form of ABPA-CB and ABPA-CB-ORF had higher serological parameters suggestive of increased systemic inflammation. Hence, ABPA may be categorized as mild (ABPA-S), moderate (ABPA-CB) and severe (ABPA-CB-ORF) categories which oscillate between remission and exacerbation phases.

• ABPA
• ABPA-CB
• ABPA-CB-ORF
• ABPA-S
• Aspergillus
• bronchiectasis
• hypersensitivity

Acknowledgements

The authors thank Dr. Mujeeb-ur-Rehman, Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi for help in statistical analysis.

The authors are thankful to Dr. Jayesh G. Kanuga, MD Clinical Assistant Professor of Allergy and Immunology, University of Medicine and Dentistry of New Jersey (UMDNJ), USA and Dr. Mansi Kanuga, MD Adult and Pediatric Allergist and Immunologist, Mayo Clinic Health System, USA, for editorial assistance.