Asia Pac Allergy.  2017 Jul;7(3):148-155. 10.5415/apallergy.2017.7.3.148.

A review of 42 asthmatic children with allergic bronchopulmonary aspergillosis

• Shah A
• Kunal S

• KMID: 2396938
• DOI: http://doi.org/10.5415/apallergy.2017.7.3.148

Abstract

BACKGROUND
Allergic bronchopulmonary aspergillosis (ABPA) in children with asthma, not associated with cystic fibrosis, is yet to receive the recognition it deserves.
OBJECTIVE
To highlight the presentation of ABPA in children with asthma.
METHODS
This retrospective review documents the occurrence of pediatric ABPA over a period of 31 years in one unit. Children with asthma, eosinophilia and infiltrates on chest radiograph were screened for ABPA. In these patients, demonstration of immediate hypersensitivity response against Aspergillus species along with serological profile and pulmonary function testing were done. Bronchography/computed tomography (CT) of the chest demonstrated central bronchiectasis (CB). CT of the paranasal sinuses was done in patients with upper airways symptoms. In those suspected with allergic Aspergillus sinusitis (AAS) consent was sought from the parents for the invasive procedure needed for the diagnosis of AAS.
RESULTS
Of the 349 patients with ABPA diagnosed, 42 (12.03%) were in the pediatric age group. The mean age on presentation was 12.9 ± 4 years with a male preponderance. All patients had asthma and positive intradermal/skin prick test against Aspergillus species. Ring shadows, the most common radiological presentation, were seen in 28 of 42 patients. Bronchography/CT of the chest demonstrated CB, a feature pathognomic of ABPA, in 32 of 42 patients. High attenuation mucus plugs was observed in 7 of 36 patients while ABPA-seropositive was diagnosed in 10 of 42 patients. On imaging, sinusitis was seen in 20 of 30 patients with upper airways symptoms of whom eight had suspected AAS. Three parents consented for surgery, which confirmed the diagnosis.
CONCLUSION
This study highlights the need to evaluate asthmatic children for ABPA as also to exclude AAS.

Keyword

Asthma; Aspergillosis, allergic bronchopulmonary; Allergic Aspergillus sinusitis; Central bronchiectasis; High attenuation mucus plugs

MeSH Terms

Aspergillosis, Allergic Bronchopulmonary*
Aspergillus
Asthma
Bronchiectasis
Child*
Cystic Fibrosis
Diagnosis
Eosinophilia
Humans
Hypersensitivity, Immediate
Male
Mucus
Paranasal Sinuses
Parents
Radiography, Thoracic
Respiratory Function Tests
Retrospective Studies
Sinusitis
Thorax

Figure

• 

  Fig. 1 (A) Chest radiograph of an 11-year-old child showing right upper zone infiltrates. (B) Chest radiograph of the same child 12 months later showing left lower zone infiltrates. (C) Chest radiograph 3 months later than panel B showing right lower zone infiltrates. (D) Chest radiograph showing clearing of the infiltrates after therapy.

• 

  Fig. 2 (A) Bronchographic image showing central bronchiectasis with normal peripheral tapering of the right upper lobe bronchus. (B) High resolution computed tomography of the chest (lung window) showing central bronchiectasis with “string of pearls” appearance (white arrow) and “signet ring” (open arrow).

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  Fig. 3 (A) Computed tomography of the paranasal sinus showing hyperdense lesion in the left maxillary sinus suggestive of “allergic mucin.” (B) High power view (×400) on haematoxylin and eosin stain showing inflammation of the nasal mucosa consisting of eosinophils, neutrophils and histiocytes. (C) High power view (×400) on Gomori methamine silver stain showing branching septate hyphae of Aspergillus.

• 

  Fig. 4 (A) Chest radiograph of a 16-year-old girl showing “gloved finger” appearance in the right upper zone (white arrow). (B) High resolution computed tomography of the chest (mediastinal window) showing high attenuation mucus. (C) High resolution computed tomography of the chest (lung window) showing bilateral lower lobe consolidation with air-bronchograms.

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