Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis
Other names	ABPA, Hinson-Pepys disease.
The chest radiograph of an allergic bronchopulmonary aspergillosis patient shown with left-sided perihilar opacity (blue arrow) along with non-homogeneous infiltrates (transient pulmonary infiltrates indicated by red arrows) in all zones of both lung fields.
The conidiophore of the fungal organism Aspergillus fumigatus.
Specialty	Pulmonology, Infectious disease
Symptoms	wheezing, coughing, shortness of breath and exercise intolerance.[1]
Complications	Asthma exacerbations, aspergilloma, chronic pulmonary aspergillosis, cavitation, local emphysema, chronic or recurrent atelectasis, and honeycomb fibrosis.[2]
Causes	Aspergillus exposure.
Risk factors	Asthma or cystic fibrosis.[1]
Diagnostic method	Chest X-rays, CT scans, blood tests, immunological tests, and sputum cultures.[2]
Differential diagnosis	Asthma with fungal sensitivity, cystic fibrosis, bronchiectasis, eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis, bronchocentric granulomatosis, tuberculosis, and sarcoidosis.[2]
Prevention	Corticosteroids and antifungal medications.[2]
Medication	Prednisolone and Itraconazole.[2]
Frequency	1–15% of cystic fibrosis patients and 2.5% of adults with severe asthma.[3]

Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterised by an exaggerated response of the immune system (a hypersensitivity response) to the fungus Aspergillus (most commonly Aspergillus fumigatus). It occurs most often in people with asthma or cystic fibrosis.^[1] Aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals. A. fumigatus is responsible for a spectrum of lung diseases known as aspergilloses.^[4]

ABPA causes airway inflammation, leading to bronchiectasis—a condition marked by abnormal dilation of the airways. Left untreated, the immune system and fungal spores can damage sensitive lung tissues and lead to scarring.^[5]

The exact criteria for the diagnosis of ABPA are not agreed upon. Chest X-rays and CT scans, raised blood levels of IgE and eosinophils, immunological tests for Aspergillus together with sputum staining and sputum cultures can be useful. Treatment consists of corticosteroids and antifungal medications.^[2]