Allergic Bronchopulmonary Aspergillosis (ABPA)

Aspergillosis is an infection caused by the fungus Aspergillus. Aspergillosis describes a large number of diseases involving both infection and growth of fungus as well as allergic responses. Aspergillosis can occur in a variety of organs, both in humans and animals. Watch a short video clip about aspergillus.
The most common sites of infection are the respiratory apparatus (lungs, sinuses) and these infections can be:

ABPA (non-invasive)

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. 1% to 5% of adult asthmatics might develop this at some time during their lives, whereas 5% to 10% of CF patients may be affected. 
Approximately 30% of all asthmatics suffer with severe (20%) or very severe (10%) asthma, and around 40% 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.

Presentation:

ABPA often presents with shortness of breath, coughing and wheezing. There may be 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 chest X-ray along with sputum, skin and blood tests. An elevated total serum IgE, together with evidence of Aspergillus sensitisation as seen by either the presence of Aspergillus antibodies, or identification from respiratory fluid, is a positive indication. Lung infiltrates are often seen on X-ray or CT scan. 
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 and the condition responds well to glucocorticoids. Inhaled steroids are ineffective. Itraconazole (an antifungal drug) has been shown to be of benefit when used in conjunction with steroids and longer term it may reduce the dosage of steroids required for ABPA treatment.