New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation
Author:
Koichiro Asano, MD, Akira Hebisawa, MD, PhD, Takashi Ishiguro, MD, PhD, Noboru
Takayanagi, MD, PhD, Yasuhiko Nakamura, MD, PhD, Junko Suzuki, MD, Naoki
Okada, MD, Jun Tanaka, MD, Yuma Fukutomi, MD, PhD, Shigeharu Ueki, MD,
PhD, Koichi Fukunaga, MD, PhD, Satoshi Konno, MD, PhD, Hiroto Matsuse, MD,
Katsuhiko Kamei, MD, Masami Taniguchi, MD, Terufumi Shimoda, MD, Tsuyoshi
Oguma, MD, Japan ABPM research program
Date: 10 September 2020
Abstract:
Background: There are several clinical diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA). However, these criteria have not been validated in detail, and no criteria for allergic bronchopulmonary mycosis (ABPM) is currently available.
Objective: We propose new diagnostic criteria for ABPA/ABPM, consisting of ten components, and compare its sensitivity and specificity to existing methods.
Methods: Rosenberg-Patterson’s criteria proposed in 1977, International Society for Human and Animal Mycology (ISHAM) criteria proposed in 2013, and our new criteria, were applied to 79 cases with pathological ABPM and the control population with allergic mucin in the absence of fungal hyphae (n = 37), chronic eosinophilic pneumonia (n = 64), Aspergillus-sensitized severe asthma (n = 26), or chronic pulmonary aspergillosis (n = 24). These criteria were also applied to the 179 cases with physician-diagnosed ABPA/ABPM in a nation-wide Japanese survey.
Results: The sensitivity for pathological ABPM with Rosenberg-Patterson criteria, ISHAM criteria, and our new criteria were 25.3%, 77.2%, and 96.2%, respectively. The sensitivity for physician-diagnosed ABPA/ABPM were 49.2%, 82.7%, and 94.4%, respectively. The area under the curve for the receiver operation characteristic curve was 0.85, 0.90, and 0.98 for Rosenberg-Patterson criteria, ISHAM criteria, and the new criteria, respectively. The sensitivity for ABPM cases that were culture-positive for non-Aspergillus fungi, were 14.3%, 47.6%, and 90.5% with Rosenberg-Patterson criteria, ISHAM criteria, and the new criteria, respectively.
Conclusion: The new diagnostic criteria showed better sensitivity and specificity for diagnosing ABPA/ABPM, compared with existing criteria.
Keywords: Allergic bronchopulmonary aspergillosis; Allergic bronchopulmonary mycosis; Aspergillus; Diagnosis; Eosinophils; Fungus; IgE; Mucus plugs; Severe asthma with fungal sensitization.
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