ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA) COMMONLY MISDIAGNOSED AS PULMONARY TUBERCULOSIS

Abstract

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA), asyndrome associated with asthma, manifests with transient pulmonaryinfiltrates and eosinophilia and can progress to severe proximalbronchiectasis, and pulmonary fibrosis. Early recognition and treatmentshould favorably influence these complications.OBJECTIVES: To study the clinical and radiologic features of the patientsof ABPA, with emphasis on their previous diagnosis and treatment especiallyof tuberculosis.DESIGN AND SETTING: Prospective recruitment of all the patients ofABPA, diagnosed at the Pulmonology unit QAMC / Bahawal VictoriaHospital Bahawalpur during 2005-06.PATIENTS AND METHODS: We studied the clinical and the radiologicalfeatures of ABPA, with special emphasis on previous diagnosis and treatmentof tuberculosis. Standardized data collection of symptoms, bacteriology, andreview of radiology by two readers blind to the clinical data was done.RESULTS: There were 672 patients of ABPA. Demographic analysis showeda preponderance of males, young patients (less than 35 years old), farmingand rural communities. 90% patients were asthmatic with long history ofwheezing. Most common symptoms were breathlessness (93 %), cough (96%), expectoration (78 %), fever (92 %), chest pain (82 %) and hemoptysis(48 %). Forty five percent patients had associated nasal symptoms. Morethan 60 % patients were erroneously diagnosed and treated as pulmonarytuberculosis while about 30 % of them took two or more courses of antituberculoustreatment.CONCLUSIONS: ABPA is more prevalent than previously appreciated. Itsclinical presentation is similar to pulmonary tuberculosis hence most cases ofABPA are misdiagnosed as pulmonary tuberculosis; delay in diagnosis andtreatment not only predisposes them to complications like bronchiectasis andfibrosis but also to potentially toxic anti–tuberculous therapy. For theclinician, it is imperative to consider the diagnosis in asthmatic patients withradiographic infiltrates and/or bronchiectasis.