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Development of chronic pulmonary aspergillosis in adult asthmatics with ABPA

Background Chronic pulmonary aspergillosis (CPA) is an occasional complication of allergic bronchopulmonaryaspergillosis (ABPA) but the transition is poorly understood. Methods All patients referred to the UK's National Aspergillosis Centre with CPA between May 2009 and June 2012 were screened with... Full description

Journal Title: Respiratory Medicine Dec 2015, Vol.109(12), pp.1509-1515
Main Author: Lowes, David
Other Authors: Chishimba, Livingstone , Greaves, Melanie , Denning, David
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 09546111 ; DOI: 10.1016/j.rmed.2015.09.007
Link: http://search.proquest.com/docview/1753626590/?pq-origsite=primo
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title: Development of chronic pulmonary aspergillosis in adult asthmatics with ABPA
format: Article
creator:
  • Lowes, David
  • Chishimba, Livingstone
  • Greaves, Melanie
  • Denning, David
subjects:
  • India
  • Studies
  • Infectious Diseases
  • Audit Departments
  • Epidemiology
  • Patients
  • Mortality
  • Medical Records
  • Radiology
  • Fungal Diseases
  • Fibrosis
  • Cavitation
  • Aspergillus Fumigatus
  • Corticosteroids
ispartof: Respiratory Medicine, Dec 2015, Vol.109(12), pp.1509-1515
description: Background Chronic pulmonary aspergillosis (CPA) is an occasional complication of allergic bronchopulmonaryaspergillosis (ABPA) but the transition is poorly understood. Methods All patients referred to the UK's National Aspergillosis Centre with CPA between May 2009 and June 2012 were screened with serum total IgE and anti-AspergillusIgE for a dual diagnosis of ABPA and CPA. Those patients suspected of having both conditions were re-evaluated and their imaging reviewed. Results Of 407 referred patients, 42 screened positive and 22 were confirmed as having both ABPA and CPA. Asthma was present from early childhood in 19 (86%), the median interval between ABPA and onset of CPA was 7.5 years; one patient developed ABPA and CPA simultaneously. Aspergillus IgG levels varied from 23 to 771 mg/L, median 82 mg/L. All 22 patients had bronchiectasis. In patients with ABPA, CT typically demonstrated varicose or cystic bronchiectasis primarily affecting segmental and proximal subsegmental upper lobe bronchi. Other findings included mucoid impaction and centrilobular nodules. Radiological changes associated with CPA included pleural thickening which was often bilateral and accentuated by adjacent hypertrophied extrapleural fat, upper lobe volume loss, thick walled apical cavities, some of which contained aspergillomas, and cavitating pulmonary nodules. CPA secondary to ABPA has more subtle radiological appearances than when due to other underlying diseases. Conclusions CPA may complicate ABPA and have distinct radiology features, in addition to bronchiectasis. A novel biomarker is required to anticipate this serious complication, as current serology is not specific enough.
language: eng
source:
identifier: ISSN: 09546111 ; DOI: 10.1016/j.rmed.2015.09.007
fulltext: fulltext
issn:
  • 09546111
  • 0954-6111
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titleDevelopment of chronic pulmonary aspergillosis in adult asthmatics with ABPA
creatorLowes, David ; Chishimba, Livingstone ; Greaves, Melanie ; Denning, David
ispartofRespiratory Medicine, Dec 2015, Vol.109(12), pp.1509-1515
identifierISSN: 09546111 ; DOI: 10.1016/j.rmed.2015.09.007
subjectIndia ; Studies ; Infectious Diseases ; Audit Departments ; Epidemiology ; Patients ; Mortality ; Medical Records ; Radiology ; Fungal Diseases ; Fibrosis ; Cavitation ; Aspergillus Fumigatus ; Corticosteroids
descriptionBackground Chronic pulmonary aspergillosis (CPA) is an occasional complication of allergic bronchopulmonaryaspergillosis (ABPA) but the transition is poorly understood. Methods All patients referred to the UK's National Aspergillosis Centre with CPA between May 2009 and June 2012 were screened with serum total IgE and anti-AspergillusIgE for a dual diagnosis of ABPA and CPA. Those patients suspected of having both conditions were re-evaluated and their imaging reviewed. Results Of 407 referred patients, 42 screened positive and 22 were confirmed as having both ABPA and CPA. Asthma was present from early childhood in 19 (86%), the median interval between ABPA and onset of CPA was 7.5 years; one patient developed ABPA and CPA simultaneously. Aspergillus IgG levels varied from 23 to 771 mg/L, median 82 mg/L. All 22 patients had bronchiectasis. In patients with ABPA, CT typically demonstrated varicose or cystic bronchiectasis primarily affecting segmental and proximal subsegmental upper lobe bronchi. Other findings included mucoid impaction and centrilobular nodules. Radiological changes associated with CPA included pleural thickening which was often bilateral and accentuated by adjacent hypertrophied extrapleural fat, upper lobe volume loss, thick walled apical cavities, some of which contained aspergillomas, and cavitating pulmonary nodules. CPA secondary to ABPA has more subtle radiological appearances than when due to other underlying diseases. Conclusions CPA may complicate ABPA and have distinct radiology features, in addition to bronchiectasis. A novel biomarker is required to anticipate this serious complication, as current serology is not specific enough.
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titleDevelopment of chronic pulmonary aspergillosis in adult asthmatics with ABPA
descriptionBackground Chronic pulmonary aspergillosis (CPA) is an occasional complication of allergic bronchopulmonaryaspergillosis (ABPA) but the transition is poorly understood. Methods All patients referred to the UK's National Aspergillosis Centre with CPA between May 2009 and June 2012 were screened with serum total IgE and anti-AspergillusIgE for a dual diagnosis of ABPA and CPA. Those patients suspected of having both conditions were re-evaluated and their imaging reviewed. Results Of 407 referred patients, 42 screened positive and 22 were confirmed as having both ABPA and CPA. Asthma was present from early childhood in 19 (86%), the median interval between ABPA and onset of CPA was 7.5 years; one patient developed ABPA and CPA simultaneously. Aspergillus IgG levels varied from 23 to 771 mg/L, median 82 mg/L. All 22 patients had bronchiectasis. In patients with ABPA, CT typically demonstrated varicose or cystic bronchiectasis primarily affecting segmental and proximal subsegmental upper lobe bronchi. Other findings included mucoid impaction and centrilobular nodules. Radiological changes associated with CPA included pleural thickening which was often bilateral and accentuated by adjacent hypertrophied extrapleural fat, upper lobe volume loss, thick walled apical cavities, some of which contained aspergillomas, and cavitating pulmonary nodules. CPA secondary to ABPA has more subtle radiological appearances than when due to other underlying diseases. Conclusions CPA may complicate ABPA and have distinct radiology features, in addition to bronchiectasis. A novel biomarker is required to anticipate this serious complication, as current serology is not specific enough.
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authorLowes, David ; Chishimba, Livingstone ; Greaves, Melanie ; Denning, David
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10Fibrosis
11Cavitation
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abstractBackground Chronic pulmonary aspergillosis (CPA) is an occasional complication of allergic bronchopulmonaryaspergillosis (ABPA) but the transition is poorly understood. Methods All patients referred to the UK's National Aspergillosis Centre with CPA between May 2009 and June 2012 were screened with serum total IgE and anti-AspergillusIgE for a dual diagnosis of ABPA and CPA. Those patients suspected of having both conditions were re-evaluated and their imaging reviewed. Results Of 407 referred patients, 42 screened positive and 22 were confirmed as having both ABPA and CPA. Asthma was present from early childhood in 19 (86%), the median interval between ABPA and onset of CPA was 7.5 years; one patient developed ABPA and CPA simultaneously. Aspergillus IgG levels varied from 23 to 771 mg/L, median 82 mg/L. All 22 patients had bronchiectasis. In patients with ABPA, CT typically demonstrated varicose or cystic bronchiectasis primarily affecting segmental and proximal subsegmental upper lobe bronchi. Other findings included mucoid impaction and centrilobular nodules. Radiological changes associated with CPA included pleural thickening which was often bilateral and accentuated by adjacent hypertrophied extrapleural fat, upper lobe volume loss, thick walled apical cavities, some of which contained aspergillomas, and cavitating pulmonary nodules. CPA secondary to ABPA has more subtle radiological appearances than when due to other underlying diseases. Conclusions CPA may complicate ABPA and have distinct radiology features, in addition to bronchiectasis. A novel biomarker is required to anticipate this serious complication, as current serology is not specific enough.
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