Clinical diagnostic criteria for allergic bronchopulmonary mycosis

K Asano1, A Hebisawa2, N Takayanagi3, Y Nakamura2, T Ishiguro3, J Suzuki2, J Tanaka1, T Oguma1

Author address: 

1Division of Pulmonary Medicine, Tokai University School of Medicine, Kanagawa, Japan 2Clinical Research Center, Tokyo National Hospital, Tokyo, Japan 3Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan

Abstract: 

Purpose: There are several clinical diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA); however, no criteria for allergic bronchopulmonary mycosis (ABPM) are currently available. We propose new diagnostic criteria for ABPM consisting of 10 components and compare these criteria’s sensitivity and specificity with that of existing methods.

Methods: The new diagnostic criteria for ABPM include patients with: 1) current or previous history of asthma or asthmatic symptoms; 2) peripheral blood eosinophilia (> 500 cells/mm3); 3) elevated levels of total serum immunoglobulin E (IgE, > 417 IU/mL); 4) immediate cutaneous hypersensitivity or presence of specific IgEs for filamentous fungi; 5) presence of precipitins or specific IgGs for filamentous fungi; 6) growth of filamentous fungi in cultures of sputum or bronchial lavage fluid; 7) presence of fungal hyphae in the mucus plugs of the bronchi; 8) central bronchiectasis on high-resolution computed tomography (HRCT); 9) presence of mucus plugs in the central bronchi, as determined by HRCT/bronchoscopy, or history of mucus plug expectoration; and 10) high attenuation mucus in the bronchi on HRCT. Patients that met 6 or more of these criteria were diagnosed with ABPM. The Rosenberg-Patterson criteria (1977), International Society for Human and Animal Mycology (ISHAM) criteria (2013), and the new criteria developed in this study were applied to 83 cases of allergic mucin in the bronchi containing fungal hyphae (which fulfilled the pathological criteria for ABPM proposed by Bosken et al. (1988)), 42 cases with allergic mucin in the absence of hyphae, and 75 cases with chronic eosinophilic pneumonia.

Results: Among the 83 cases with pathological ABPM, 34 (41%), 62 (75%), and 71 (93%) cases fulfilled the Rosenberg-Patterson criteria, ISHAM criteria, and our new criteria, respectively. On the other hand, only 3 (7%), 4 (10%), and 4 (10%) cases with hyphae-negative allergic mucin, and 0 (0%), 3 (4%), and 0 (0%) cases with chronic eosinophilic pneumonia, were matched with these 3 criteria. ROC curve analysis using all cases confirmed that the new criteria can diagnosis ABPM with a sensitivity and specificity of 92.8% and 96.6%, respectively, with an AUC of 0.99. However, specificity and AUC was 97.4% and 0.92 for the Rosenberg-Patterson criteria and 94.0% and 0.93 for the ISHAM criteria, respectively.

Conclusion: The new diagnostic criteria showed a better sensitivity and superior specificity for diagnosing ABPA/ABPM, when compared to existing criteria.

2018

Full conference title: 

The 8th Advances Against Aspergillus, Lisbon Conference Center, Lisbon, Portugal
    • AAA 8th (2018)