Clinical Diagnostic Criteria for Allergic Bronchopulmonary Mycosis

K. Asano1, A. Hebisawa2, N. Takayanagi3, M. Taniguchi4, Y. Nakamura5, T. Ishiguro3, J. Tanaka1, K. Watai4, Y. Fukutomi4, J. Suzuki2, T. Oguma1;

Author address: 

1Division of Pulmonary Medicine, Tokai University School of Medicine, Kanagawa, Japan, 2Tokyo National Hospital, Tokyo, Japan, 3Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan, 4Sagamihara National Hospital, Sagamihara, Japan, 5Toho University School of Medicine, Tokyo, Japan.

Abstract: 

Backgrounds: There are several clinical diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA); however, no criteria for allergic bronchopulmonary mycosis (ABPM) are currently available. Objectives: We propose new diagnostic criteria for ABPM consisting of 10 components (Table 1) and compare these criteria’s sensitivity and specificity with that of existing methods. Methods: 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. We also examined 26 cases with severe asthma sensitized with Aspergillus sp. which did not fulfill the Rosenberg-Patterson criteria. 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. Six (23%) and 1 (4%) cases with Aspergillus-sensitized severe asthma were diagnosed as ABPA/ABPM by ISHAM and our criteria, respectively. ROC curve analysis using all cases confirmed that the new criteria can diagnosis ABPM with a sensitivity and specificity of 92.8% and 96.5%, respectively, with an AUC of 0.98. On the other hand, specificity and AUC was 97.9% and 0.91 for the Rosenberg-Patterson criteria and 90.9% and 0.91 for the ISHAM criteria. Conclusion: The new diagnostic criteria showed a better sensitivity and superior specificity for diagnosing ABPA/ABPM, when compared to existing criteria.

Tables: 

2018

abstract No: 

A1357 / P882

Full conference title: 

The American Thoracic Society Conference 2018
    • ATS 2018