Pulmonary aspergillosis - allergic bronchopulmonary type

• Illustrations
• Alternative names
• Definition
• Causes, incidence, and risk factors
• Symptoms
• Signs and tests

• Treatment
• Expectations (prognosis)
• Complications
• Calling your health care provider
• Prevention

Alternative names    Return to top

Definition    Return to top

Pulmonary aspergillosis is an allergic reaction to a fungus called aspergillus, which causes inflammation of the airways and air sacs of the lungs.

Causes, incidence, and risk factors    Return to top

The aspergillus fungus is common. It can grow on dead leaves, stored grain, bird droppings, compost stacks and other decaying vegetation. Although most people are frequently exposed to aspergillus, infections caused by it such as a pneumonia or fungus ball (aspergilloma) are rare.

Some people, however, have an allergic reaction (hypersensitivity) to this fungus, which is called allergic bronchopulmonary aspergillosis (ABPA). It is characterized by inflammation of the airways (bronchi) or air sacs (alveoli). The disease may mimic asthma or pneumonia, and, in fact, most patients with ABPA have asthma as well.

Patients with asthma or cystic fibrosis are at highest risk for allergic aspergillosis.

Symptoms    Return to top

• worsening symptoms of asthma
• wheezing
• cough may produce brownish plugs or bloody sputum
• fever

Signs and tests    Return to top

• elevated CBC eosinophil count
• elevated serum IgE antibodies: total IgE level and level of IgE specific for aspergillus
• aspergillus antigen skin test
• positive serum aspergillus antibodies
• chest X-ray showing infiltrates and finger-like shadows
• chest CAT scan showing central bronchiectasis (dilation of the airways) or mucous plugging
• sputum stain and culture for fungus
• bronchoscopy with cultures and transbronchial biopsy
• rarely lung biopsy is required

Treatment    Return to top

Allergic aspergillosis is treated with oral prednisone. The anti-fungal antibiotic, itraconazole, can also be helpful. People with asthma should also continue their usual inhaler treatments.

Expectations (prognosis)    Return to top

The response to therapy is usually good, with improvement over time. Relapses requiring repeat treatment are common.

Complications    Return to top

• irreversible airway obstruction
• bronchiectasis
• mucous plugging
• respiratory failure

Calling your health care provider    Return to top

Call your health care provider if symptoms of this disorder develop.

Call your health care provider if breathing becomes more difficult. Severe breathing difficulty is an emergency.

Prevention    Return to top

People with predisposing factors (asthma, cystic fibrosis, etc.) should try to avoid environments where this fungus is found if possible.