Allergic BronchopulmonaryAspergillosis ABPA

Allergic BronchopulmonaryAspergillosis ABPA

Allergic BronchopulmonaryAspergillosis

Hypersensitivity to aspergillus inpatients with long standing asthma

AspergillosisClassification

Non-invasive aspergillosis

Fungus ball found in old TB cavity

Invasive pulmonary aspergillosis

Lymphoma/leukemia patients

Multiple nodules which may cavitate

Frequently fatal

Allergic bronchopulmonary aspergillosis

Acute ABPA

Type I reaction

Immediate hypersensitivity (IgE-mediated)

Histologically

Alveoli filled with eosinophils

Chronic ABPA

Type III reaction

Delayed immune complex response=Arthusreaction (IgG-mediated)

Histologically

Damage to bronchial wall

ABPAX-ray Appearance

Patchy, fleeting infiltrates

Usually in upper lobes

Thickened bronchial walls

“Finger-in-glove” “toothpaste shadow”

Mucus plugs in bronchi remain for months andgrow in size

Central bronchiectasis

Ring shadows around hilum

ABPAX-ray Appearance

Lobar consolidation (32%)

Atelectasis (14%)

Cavitation (14%)

Pulmonary fibrosis

ABPADiagnostic Criteria

Asthma

Blood eosinophilia

Immediate skin rx to aspergillus

Elevated IgE

Central bronchiectasis