Background: Allergic bronchopulmonary aspergillosis (ABPA) significantly impairs respiratory
function in patients with cystic fibrosis (CF). In CF patients the frequency of sensitization to
Aspergillus spp. is 27-41% and the incidence of ABPA ranges from 2 to 15%.
Objectives: To study the prevalence of fungal sensitization and frequency of ABPA in
patients with CF in Saint-Petersburg, Russia.
Material/methods: We observed 115 patients with CF between 1 and 37 years old (median
age -11 years), males – 67, females – 63. All patients underwent skin tests with six fungal
allergens, determination of total IgE level (by enzyme immunoassay) and specific IgE to
fungal allergens in serum, and IgG to Aspergillus fumigatus. Microscopic examination of
sputum and sputum culture were done. Specific IgE to fungal, domestic and epidermal
allergens were determined with multiple allergen simultaneous test-chemiluminescent assay
(MAST-CLA; Chemical Diagnostics, Inc., USA). In case of ABPA suspicion computed
tomography of the chest was performed. Detection of specific serum IgE to fungal allergen
(class ≥ 1) was considered as criterion of fungal sensitization. Diagnostic criteria of ABPA
[Stevens et al, 2003] were used.
Results: Total serum IgE level varied from 1 to 3861 IU/ml (median - 18 (7,0÷ 107,0).
Sensitization to fungi by positive skin prick tests and/or by specific serum IgE level to fungal
allergens was identified in 71 patients (62%): Candida spp. (57%), Alternaria spp. (31%),
Aspergillus spp. (20%), Rhizopus spp. – 20%, Penicillium spp. – 12%, and Cladosporium spp. –
5%. ABPA was diagnosed in 8 patients (7%). In all ABPA patients sputum culture showed
growth of Aspergillus: Aspergillus fumigatus in 5 patients and Aspergillus niger in 3 patients.
Conclusions: The frequency of fungal sensitization in cystic fibrosis patients was 62%,
sensitization to Candida spp. - 57%, Alternaria spp. - 31% and Aspergillus spp. - 20%. ABPA
was diagnosed in 7% patients. All patients with cystic fibrosis need allergy screening for
timely detection and adequate treatment of ABPA.
Full conference title:
- ECCMID 27th (2017)