Allergic bronchopulmonary aspergillosis: Indian scenario

Abstract

Aspergillus is ubiquitous, occurring in mycelial form and grows at 15-530C and humid conditions. Pulmonary aspergillosis is a clinical spectrum of lung disease caused by the fungus Aspergillus. ABPA is the commonest disease among allergic bronchopulmonary mycoses. The exact prevalence of ABPA is not known but contemporary estimates suggested that ABPA complicates 1 to 11% of all chronic cases of bronchial asthma. The basic underlying immuno-pathophysiologic process in ABPA is a hypersensitivity reaction to fungus in the bronchial tree. Patients are usually atopic with previous history of bronchial asthma. The onset is insidious with constitutional symptoms like anorexia, fatigue, weight loss, headache, generalized aches and pains, and low-grade fever. It is characterized by repeated episodes of exacerbation with periods of remission, if untreated may progress to fibrotic lung disease. Patients with chronic fibrotic disease may present with cyanosis, corpulmonale and respiratory failure. Radiologically fleeting shadows are characteristic of ABPA. Bronchiectasis, centrilobular nodules and mucoid impaction are main features of ABPA seen in CT scan thorax. Oral corticosteroid remains the cornerstone for the treatment of ABPA. Optimization of baseline asthma therapy is essential. Early diagnosis and proper treatment may alter the prognosis of disease and further prevent end stage lung fibrosis.