Clinical Experience with Allergic Bronchopulmonary aspergillosis in a tertiary care hospital

Imranullah Khan, Raza Ullah, Kashif Aziz, Muhammad Irfan, Nousheen Iqbal, Syed Wasib Hussain Shah, Zafar Iqbal

Abstract


Background: Allergic bronchopulmonary aspergillosis (ABPA) is hypersensitivity reaction to Aspergillus antigen. It occurs in patients with asthma and cystic fibrosis (CF) and manifest as fever and pulmonary infiltrates unresponsive to antibiotics.

Objective: Objective of the present study was to analyze clinical experience with ABPA in tertiary care center. 

Methodology: It is an observational study. Patients data with diagnosis of ABPA from AKUH (agha khan university hospital) admitted in 2016 were collected retrospectively. Patients who fulfilled the ISHAM (International Society for Human and Animal Mycology) criteria were included. History, disease stage, radiological findings, Spirometry, treatment and outcome were recorded on predefined questionnaire. SPSS V21 was used for data analysis.

Results: Out of 120 patients, 64 fulfilled the criteria for ABPA. Mean duration of ABPA was 4 years. 25% were misdiagnosed as pulmonary Tuberculosis. Mean Eosinophil count was 1111/mm2. Serum IgE level was above 2000 IU in 88% of patients. Mean age of patients were 32±12 years. 49% of them were males. 22% were having acute flare, 33% were having remission, 22% were steroid dependent and 1% had fibrotic lung disease. Most common symptoms were cough 88%, fever 66% and wheeze 56%. 55% had central bronchiectasis on HRCT. 28% had aspergillus fumigatus, 18% aspergillus flavus, 20% pseudomonas aerogenosa and 11% had streptococcus pneumonia on sputum culture.

Conclusion: ABPA is commonly misdiagnosed as pulmonary TB in high burden TB country. Early diagnosis and appropriate treatment can prevent the structural damage to the lungs.


Keywords


ABPA; AKUH; Pulmonary TB

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