Introduction: Aspergillus lung infection is classified into three categories; i.e. invasive and chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis (ABPA). We often encounter patients with fungal hyphae-containing bronchial mucus plugs similar to ABPA but without asthma symptoms. Current diagnostic criteria
Historically, mucus plugs with eosinophils and fungal hyphae have been considered as important histopathological features since the time when ABPA was first described in 1952 by Hinton. Bosken et al. described mucus plugs with eosinophils and fungal hyphae were diagnostic of ABPA. However, the Rosenberg-Patterson criteria referred to mucus plugs in only minor criteria, and the new diagnostic criteria proposed by International Society for Human and Animal Mycology (ISHAM) working group in 2013 had no reference to mucus plugs, putting more weight on immunological tests.
In this study, we focused on cases with fungal hyphae-containing mucus
Methods: A total of 97 patients with pathological examination of mucus plugs were retrospectively selected from January 1992 to December 2016. Medical records were reviewed regarding the diagnosis of ABPA and bronchial asthma.
Results: Among 97 patients with mucus plugs, 55 patients had mucus plugs with eosinophils and fungal hyphae.
Conclusion: Substantial number of cases with fungal hyphae-containing eosinophilic bronchial mucus plugs met ABPA criteria except for asthma symptoms. ABPA without asthma may be more common than previously thought.
Full conference title:
- ATS 2018