TABLE 1

Differences between Aspergillus fumigatus colonisation/infection and disease diagnosis and presentation in people with cystic fibrosis [13, 40, 41]

Colonisation/infectionDisease
AspergillomaAspergillus bronchitis/bronchiolitisABPA
Diagnostic tests
 Fungal airway culture++#++
 Positive RT-PCR++++
Serology
  Total IgE==/↑↑↑
  A. fumigatus-specific IgE/IgG=−/↑
  Galactomannan
Signs and symptoms
 Clinical symptoms (productive cough, tenacious sputum, breathlessness or haemoptysis)==/↑=/↑↑↑
 Pulmonary function=/↓=/↓
Most common imaging features
 CRNone/aspecificSpherical/ovoid mass within a cavity (Monod sign)Bronchopneumonia pattern with alveolar or peribronchial opacityTransitory alveolar opacities, central mucus plugs (finger in glove sign)
 CTBWT, low attenuation regions increased, some mucus plugsFungal ball in pre-existing cavityBronchiolits pattern with centrilobular nodules, tree-in-bud, BWT, BE, GGO, peribronchial consolidationCentral BE with mucus plugs and mucus with high density (30% of cases, attenuation value >70 HU)
 MRILow intensity regions (representing trapped air or hypoperfusion), T2 hyperintense plugsMonod sign: fungal ball with low T1WI and T2WI signalBWT, T2WI hyperintense peribronchial consolidation and peripheral mucus plugs (tree-in-bud+)BWT and T2 hyperintense mucus plugs (in 30% of cases inverted mucus sign, mucus with high T1WI and low T2WI signal)

−: Absent; +: present; =: normal levels; ↑: increase; ↓: decrease. RT-PCR: real-time polymerase chain reaction; CR: chest radiograph; CT: computed tomography; MRI: magnetic resonance imaging; BWT: bronchial wall thickening; BE: bronchiectasis; GGO: ground glass opacities; HU: Hounsfield Unit; T1WI: T1 weighted images; T2WI: T2 weighted images; ABPA: allergic bronchopulmonary aspergillosis. #: Particularly if no other organisms are isolated from repeated sputum cultures. : Crescentic shape of the mass with surrounding air. +: Mucus impaction in branching bronchioles.