Allergic bronchopulmonary aspergillosis

Question 1

definition

Answer 1

= pulmonary hypersensitivity disorder recognized with increased frequency in USA

Question 2

causes

Answer 2

by allergy to antigens of Aspergillus (species that colonize the tracheobronchial tree and usually occurs in atopic asthmatic individuals who are 20-40Y)

Question 3

Primary criteria for diagnosis

Answer 3

• clinical history of asthma,
• periphereal eosinophilia,
• immediate skin reactivity to Aspergillus antigen,
• precipitating antibodies to Aspergillus antigen,
• elevated serum IgE levels,
• pulmonary infiltrates
• central bronchiectasis

Question 4

secondary diagnostic criteria

Answer 4

• > Identification of Aspergillum in the sputum

- > Late- skin reactivity to Aspergillus antigen

Question 5

ttt of choice

Answer 5

corticosteroids with excellent response.
prednisone 0,5 mg/kg/d given as a single morning dose for several weeks before transition to alternate day dosing.
several months of prednisone therapy may be required

Question 6

complications

Answer 6

hemoptysis, severe bronchiectasis and pulmonary fibrosis

Question 7

advances in therapy for aspergillosis: what’s the traditional gold standard of therapy?

Answer 7

Amphotericin B

Question 8

advances in therapy for aspergillosis: what’s the first azalea with proven activity?

Answer 8

Itraconazole (safe and well tolerated)

Question 9

IDSA guidelines for using Itraconazole: who can take oral form? transition from amphotericin B initial therapy to itraconazole?

Answer 9

• > patients who are compliant and have no absorption problems
• > transition is particularly attractive