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- Title
Prevalence of allergic bronchopulmonary aspergillosis in patients with allergic-asthma by using various diagnostic criteria.
- Authors
Mortezae, Vida; Mahdaviani, Seyed Alireza; Mirenayat, Maryam Sadat; Poorabdollah, Mihan; Hassanzad, Maryam; Bongomin, Felix; Maleki, Maedeh; Heshmatnia, Jalal; Fakharian, Atefeh; Vakili, Mahshid; Hedayati, Newsha; Hedayati, Mohammad T.
- Abstract
Introduction: Asthma is a chronic inflammatory and heterogeneous respiratory syndrome with an estimated global burden of 300 million people. Occupational exposure to allergens (including fungal allergens), stress and microbial infections increase symptoms. Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction to Aspergillus antigens, which is induced by repeated inhalation of Aspergillus spores. An undiagnosed and untreated ABPA can cause progressive pneumonia, bronchiectasis, chronic production of sputum, loss of lung function, and inappropriate control of asthma and eventual respiratory failure. In the present study, we determined the prevalence of ABPA in individuals with allergic-asthma by four different diagnostic methods. Materials and Methods: Tow hundred consecutive adults patients from different places of Iran, with spirometry and clinical confirmed diagnosis of allergic bronchial asthma were evaluated in this study. All patients underwent for Aspergillus skin prick test, total IgE (= 417 KUA/L), elevated level of Aspergillus-specific IgE (> 0.35 KUA/L), Aspergillus-specific IgG = 26.9, spirometry tests, chest radiography and/or high-resolution computed tomography scan (HRCT), peripheral blood eosinophil count and also sputum direct microscopy and culture for detecting of Aspergillus. The ABPA in patients was evaluated by four diagnostic criteria including Rosenberg & Patterson criteria (A), ISHAM working criteria (B), Agarwal criteria (C) and Greenberger criteria (D). In final, the prevalence of ABPA was estimated as per the each diagnostic criteria. The four diagnostic criteria were compared to evaluation of their concordance and discordance, sensitivity and specificity. Result: During the study, 200 patients with moderate (51.5%) to severe (48.5%) allergic bronchial asthma were included. Out of 200 patients, 111 (55.5%) were female and the mean (range) age of patients was 45.8±13.03 (18-78) years with a mean (±SD) asthma duration of 10.04 (±9.94) years. The mean (range) of total IgE and Aspergillus-specific IgE levels were 316.3 (6-1300) kU/L and 1.5 (0.1-61.3) kU/L in asthmatic patients, respectively. In total, 27 (13.5%), 65 (32.5%), 22 (11.0%) and 83 (41.5%) of patients were positive to AST, total IgE, and Aspergillus-specific IgE an IgG, respectively. Blood eosinophil count greater than 500 cell/µl were reported in 29.5% (59/200) of patients. Fourteen percent (28/200) of patients with allergic asthma had evidence of bronchiectasis in HRCT. Using A, B, C, and D criteria the prevalence of ABPA were 5%, 2.5%, 2.5% and 5% respectively. Raising the total IgE cut-off value to >1000KUA/L reduced the number of ABPA as per criteria B and C, but not by criteria A and D. Five additional patients were diagnosed with ABPA as per criteria A and D, who were labelled not to have ABPA by criteria C and B. By using Rosenberg & Patterson criteria as gold standard hypothetically, sensitivity and specificity of criteria B and C were 62.5% and 100%, and criteria D were 100% and 100% like criteria A. Conclusion: Although differences observed between the number of diagnosed ABPA patients using the four criteria but the number of ABPA patients diagnosed by criteria A and D, sensitivity and specificity were equal and criteria B and C had similarity in the number ABPA patients, sensitivity and specificity. There was discordance in 5 patients when the four criteria were compared.
- Subjects
IRAN; ASPERGILLOSIS diagnosis; ASTHMA diagnosis; ALLERGIES; CONFERENCES &; conventions; DIAGNOSIS
- Publication
Current Medical Mycology, 2018, Vol 4, p105
- ISSN
2423-3439
- Publication type
Article
- DOI
10.18502/cmm.4.S1.2018.180