Prevalence of Allergic Broncho Pulmonary Aspergillosis in patients with Asthma attending allergy clinic in a North West Indian Tertiary Care Institute
DOI:
https://doi.org/10.7439/ijbar.v7i5.3253Keywords:
Low dose magnesium sulphate (Dhaka) regime, Pritchard regime, Eclampsia, Maternal and foetal outcomeAbstract
Context: Allergic Broncho Pulmonary Aspergillosis (ABPA) is an allergic disorder. Aspergillus fumigatus is the most common pathogen responsible for occurrence of ABPA. There can be serious consequences of ABPA including worsening of symptoms of asthma and more sinister complications like extensive fibrosis and bronchiectasis. Aims: To find out the prevalence of ABPA among asthma patients and association of former with factors like age, sex, occupation, family history of bronchial asthma, socioeconomic status and other relevant factors. Settings and Design: This study was a descriptive type of observational study conducted at our tertiary care institute. Methods and Material: Three hundred severe asthmatic patients underwent skin prick test (SPT) for five Aspergillus species. Four tests were applied to all SPT positive patients -Total serum IgE, spirometry, chest x-ray and High-resolution Computed Tomography (HRCT) scan of thorax. The diagnosis of ABPA was made when the patient fulfilled at least three out of four criteria. Results: Out of 300 severe asthmatic patients 27 (9%) patients were found SPT positive. Out of these 27 SPT positive patients, four patients refused for further investigations, and 23 were investigated further. Out of 23 SPT positive patients, eight patients (2.7%) were diagnosed as ABPA. It was also found that two out of eight patients with ABPA were misdiagnosed and treated earlier as pulmonary tuberculosis. Conclusions: All patients with bronchial asthma should be screened for ABPA by skin test for Aspergillus . There is need to implement screening programme and meticulous approach by physicians to diagnose and treat such patients. Key Messages: A diagnosis of allergic bronchopulmonary aspergillosis should be considered in patients coming with asthma. Skin prick test can be used to screen such patients. A further workup of the skin test positive patients leads to a high diagnostic yield.Downloads
References
Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol 2013; 51(4):361-70.
Schwartz HJ, Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma determined by serologic and radiological criteria in patients at risk. J Lab Clin Med 1991; 117:138
Agarwal R, Gupta D, Agarwal AN, Behera D, Jindal SK. Allergic bronchopulmonary aspergillosis: lesson from 126 patients attending a chest clinic in north India. Chest 2006; 130:442-8.
Kumar R, Gaur SN. Prevalence of allergic bronchopulmonary aspergillosis in patients with bronchial asthma. Asian Pac J Allergy Immunol 2000; 18:181
Maurya V, Gugnani HC, Sarma PU, Madan T, Shah A. Sensitization to Aspergillus antigens and occurrence of allergic bronchopulmonary aspergillosis in patients with asthma. Chest 2005; 127(4):1252-9.
Agarwal R, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A, Jindal SK. Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis: an analysis of 155 patients. Chest. 2007 Oct;132(4):1183-90
Prasad R, Garg R, Sanjay, Dixit RP. A study on prevalence of allergic bronchopulmonary aspergillosis in patients of bronchial asthma. Internet J Pulmonary Med. Available from URL : http:// connection.ebscohost.com / c/ articles/ 30030236/ study-prevalence- allergic-bronchopulmonary- aspergillosis- patients- bronchial- asthma. Accessed on: 22nd February 2014.
Sarkar A, Mukherjee A, Ghoshal AG, Kundu S, Mitra S. Occurrence of allergic bronchopulmonary mycosis in patients with asthma: An Eastern India experience. Lung India 2010; 27(4): 212
Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI) Global strategy for asthma management and prevention. Bethesda (MD): Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI); 2006. p. 339. Available from: www.ginasthma.com.
Shivpuri DN. Comparative evaluation of sensitivity of common methods of diagnostic antigen tests in patients of respiratory allergy. Indian J Chest Dis 1962; 4:102.
Gupta RK, Chandr A, Gautam PB. Allergic bronchopulmonary aspergillosis-a clinical review. J Assoc Physicians India. 2012 Apr; 60:46-51.
Ma YL, Zhang WB, Yu B, Chen YW, Mu S, Cui YL. Prevalence of allergic bronchopulmonary aspergillosis in Chinese patients with bronchial asthma. Zhonghua Jie He He Hu Xi Za Zhi 2011; 34(12):909-13.
Eaton T, Garrett J, Milne D, Frankel A, Wells AU. Allergic bronchopulmonary aspergillosis in the asthma clinic. A prospective evaluation of CT in the diagnostic algorithm. Chest 2000; 118(1):66-72.
Al-Mobeireek AF, El-Rab MOGAD, Al-Hedaithy SS, Alasali K, Al-Majed S, Joharjy I. Allergic bronchopulmonary mycosis in patients with asthma: period prevalence at a university hospital in Saudi Arabia. Respir Med 2001; 95(5):341-7.
Attapattu MC. Allergic bronchopulmonary aspergillosis among asthmatics. Ceylon Med J 1991; 36:45
Hendrick DJ, Davies RJ, D'Souza MF, Pepys J. An analysis of skin prick test reactions in 656 asthmatic patients. Thorax. 1975 Feb; 30(1):2-8.
Schwartz HJ, Citron KM. A comparison of the prevalence of the sensitization to Aspergillus antigens among asthmatics in Cleveland and London. J Allergy Clin Immunol1978; 62:9
Malo JL, Paquin R. Incidence of immediate sensitivity to Aspergillus fumigatus in a North American asthmatic population. Clin Allergy 1979; 9:377
Benatar SR, Keen GA, Du Toit Naude W. Aspergillus hypersensitivity in asthmatics in Cape Town. Clin Allergy 1980; 19:285
Gaur SN, Khan ZU, Kumar R. Youngest patient of ABPA in Indian subcontinent
Greenberger PA. Allergic Bronchopulmonary Aspergillosis. In: Adkinson NF YJ, et al., ed. Middleton's Allergy Principles & Practice. Vol 2. Sixth ed: Mosby; 2003:1353-71.
Behera D, Guleria R, Jindal SK, Chakrabarti A, Panigrahi D. Allergic bronchopulmonary aspergillosis: a retrospective study of 35 cases. Indian J Chest Dis Allied Sci 1994; 36(4):173-9.
Chakrabarti A1, Sethi S, Raman DS, Behera D. Eight-year study of allergic bronchopulmonary aspergillosis in an Indian teaching hospital. Mycoses. 2002 Oct; 45(8):295-9.
Agarwal R. Allergic bronchopulmonary aspergillosis. Chest 2009; 135(3):805-26.
Cooper PJ1, Vaca M, Rodriguez A, Chico ME, Santos DN, Rodrigues LC, Barreto ML. Hygiene, atopy and wheeze-eczema-rhinitis symptoms in schoolchildren from urban and rural Ecuador. Thorax. 2014; 69(3):232-9.
Kumar R, Singh P. Epidemiologic Aspects of Allergic Bronchopulmonary Aspergillosis. Clinical Pulmonary Medicine 2004; 11: pp 65-70. Available from URL: http://journals.lww.com/clinpulm/Abstract/2004/03000/Epidemiologic_Aspects_of_Allergic_Bronchopulmonary.1.aspx. Accessed on: 22nd February 2014.
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
How to Cite
