Allergic bronchopulmonary aspergillosis

The most common sites of infection are the respiratory apparatus (lungs, sinuses) and these infections can be:

• Invasive (e.g. Invasive Pulmonary Aspergillosis - IPA)
• Non-invasive (e.g. Allergic Pulmonary Aspergillosis - ABPA)
• Chronic pulmonary and aspergilloma (e.g chronic cavitary, semi- invasive)
• Severe asthma with fungal sensitisation (SAFS)

This is a condition, where a patient develops an allergy to the spores of the Aspergillus moulds. Predominantly it affects asthma patients, those with cystic fibrosis (CF) and patients with bronchiectasis. Approximately 1 to 5% of adult asthmatics might develop this at some time during their lives, whereas 5-10% of CF patients may be affected.
Approximately 30% of all asthmatics suffer with severe (20%) or very severe (10%) asthma, and around 30-50% of both these groups are also sensitised to numerous different fungi - these patients have been grouped into a new category called Severe Asthma with Fungal Sensitisation or SAFS -click for more info.

Presentation:

ABPA often presents with shortness of breath, coughing, wheezing and pulmonary infiltrates, which do not respond to conventional antibiotics in asthma/CF sufferers. The symptoms are similar to those of asthma: intermittent episodes of feeling unwell, coughing and wheezing. Some patients cough up brown-coloured plugs of mucus. The diagnosis can be made by X-ray or by sputum, skin or blood tests - an elevated total serum IgE, together with evidence of Aspergillus sensitisation as seen by either the presence Aspergillus antibodies, or identification from respiratory fluid.
In the long term ABPA can lead to permanent lung damage (fibrosis) if left untreated.

Treatment:

Oral long-term, high-dose steroids are the usual method of management. Inhaled steroids are ineffective. Itraconazole (an antifungal drug) has been shown to be of benefit when used in conjunction with steroids and longer term may reduce the dosage of steroids required for ABPA treatment.

For more information on aspergillus and its diseases and a multilingual translation click here

Example images

We have an extensive collection of images of some of the many hundreds of species of aspergillus, though only a small number of these are known to cause aspergillosis. All of these images can be viewed once you have registered, but here you can view a sample :

• Invasive pulmonary aspergillosis - x-ray before and after antifungal treatment
• Allergic bronchopulmonary aspergillosis (ABPA) - normal and infected
• Aspergillus fumigatus macro and microscopic views
• Aflatoxicosis - the effects of toxins released by some species in food