Allergic Bronchopulmonary Mycosis

Question 1

Allergic Bronchopulmonary Mycosis is

Answer 1

• a pulmonary hypersensitivity disorder caused by allergy to fungal antigens that colonize the tracheobronchial tree
• usually occurs in atopic asthmatic individuals who are 20-40 yrs in response to Ags vs. Aspergillus
• called allergic bronchopulmonary aspergillosis (ABPA)

Question 2

Primary criteria for Dx of ABPA include

Answer 2

1) clinical Hx of asthma
2) peripheral eiosinophilia
3) immediate skin rxn to Aspergillus Ag
4) precipitating Abs to Aspergillus Ag
5) elevated serum IgE levels
6) pulmonary infiltrates (transient or fixed)
7) central bronchiectasis
* if 6/7 present, Dx is almost certain

Question 3

Secondary Dx criteria include

Answer 3

• identification of Aspergillus in sputum
• Hx of brown-flecked sputum
• Late skin reactivity to Aspergillus Ag

Question 4

Treatment of choice for ABPA

Answer 4

• High dose prednisone (0.5-1 mg/kg PO/day) for at least 2 months
• Prednisone can be tapered depending on situation

Question 5

ABPA relapses

Answer 5

• frequent

- protracted or repeated Tx with corticosteroids common

Question 6

Patients with corticosteroid-dependent disease may benefit from what drug?

Answer 6

• Itraconazole (200mg orally 3x/day with food for 3 days, followed by twice daily for at least 16 weeks) without added toxicity
• Bronchodilators also helpful

Question 7

Complications of ABPA include

Answer 7

hemoptysis, severe bronchiectasis, pulmonary fibrosis