Noninvasive Pulmonary Aspergillus Infections
Section snippets
Allergic bronchopulmonary aspergillosis
ABPA is caused by an exaggerated hypersensitivity reaction to antigens produced by Aspergillus species, most commonly A fumigatus. It was first described by Hinson and colleagues4 in 1952. The pathogenesis of the disease is complex and is thought to be attributable to several immunologic and genetic predisposing host factors. Although A fumigatus is the most common cause of ABPA, other fungi have been implicated, giving rise to the term allergic bronchopulmonary mycosis (ABPM).5 ABPA is most
Diagnostic challenges
Recognizing specific immunity toward Aspergillus antigens is key in making the diagnosis of ABPA. Unfortunately, there is a lack of antigen standardization, and different laboratories use different antigen preparations to establish the diagnosis.97 Growth conditions, nutrients, culture media, and genetic variation may account for the expression of different proteins under different conditions, which results in variability among laboratories.98 More than 20 recombinant purified allergens,
Aspergilloma
Aspergilloma is defined as the presence of a fungus ball inside a cavity or dilated airway. Histologically, aspergillomas are a mixture of septate hyphae, fibrin, mucus, cellular debris, and other blood products.134 The most common associated underlying disease leading to cavity formation is TB; however, aspergilloma has been reported with sarcoidosis, emphysema, bronchiectasis, ankylosing spondylitis, and other prior infections.135, 136, 137, 138
Initially, aspergillomas were classified as
Chronic pulmonary aspergillosis
Although invasive aspergillosis and ABPA are fairly well defined, chronic forms of Aspergillus infection span a wide range of clinical presentations and histopathologic findings. As mentioned previously, the surgical literature has broken aspergillomas into simple (thin-walled with fungus ball alone) and complex (CCPA; thick-walled with surrounding parenchymal infiltration). Chronic necrotizing aspergillosis (CNA), also known as semi-invasive aspergillosis, is thought to be a distinct form of
Summary
Pulmonary aspergillosis can cause a wide spectrum of disease depending on underlying host immune function. This includes allergic or hypersensitivity reactions (ABPA), saprophytic infections (aspergilloma), and chronic disease (CPA). ABPA is most commonly seen in patients who have asthma or CF and results from a combination of cellular, humoral, and cytokine interactions. Patients may have refractory respiratory symptoms, fleeting infiltrates, elevated IgE, and eosinophilia. Early diagnosis is
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