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    Add as Friendallergic broncopulmonary aspergillosis

    by: vidyasagar

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    1 : Allergic Bronchopulmonary Aspergillosis B. VIDYASAGAR PROF & HEAD, DEPT. OF CHEST DISEASES J.J.M.MEDICAL COLLEGE DAVANGERE 577004 INDIA
    2 : ASPERGILLUS is one of the large groups of imperfect fungi having no known sexual stage, it has a hyphal form and reproduces by producing spores which are generally less than 3 mm in diameter and are dispersed by wind It is from its resemblance to the ASPERGILLUM of the catholic ritual that the organism takes its name
    3 : The genus Aspergillus includes several species known to have pathogenic effect on man Aspergillus fumigatus Asp.Niger Asp.terreus Asp.clavatus Asp.glaucus Asp.nidulans
    4 : Aspergillus species are unique among the fungi in the number of different pathological reactions with which they may be associated. Inhalation is the primary route of entry in to the man 1. Higher spore counts in the air-acute severe asthma 2. Hypersensitive reactions in asthmatics-allergic bronchopulmonary Aspergillosis 3. Exposure to very high spore counts - extrinsic allergic alveolitis 4. Spores germinating in old cavities-Aspergilloma 5. Immuno compromised host-local invasion / dissemination
    5 : ABPA Is the Most Frequently Recognized Manifestation of Aspergillosis, It Occurs World Wide First recognized in England in 1952 First recognized in India in 1971 ABPA is predominantly a disease of the asthmatics, only a very few asthmatics actually suffer from it In spite of familial preponderance of asthma,familial occurrence ABPA is a rarity Incidence 1 to 6% of all chronic bronchial asthma Cystic fibrosis is another condition,often complicated by ABPA Epidemiologic study of cystic fibrosis-ABPA is 2%
    6 : ASPERGILLUS Associated Respiratory Disorders I. Allergic ASPERGILLOSIS A. Allergic bronco pulmonary ASPERGILLOSIS - ABPA B. IgE MEDIATED ASTHMA C. Hypersensitivity PNEUMONITIS D. Allergic ASPERGILLUS sinusitis II. Saprophytic colonization - ASPERGILLOMA III. Invasive disease A. Invasive disseminated ASPERGILLOSIS B. Chronic NECROTISING pneumonia
    7 : Diagnostic Criteria For ABPA Major criteria Asthma Presence of radiologic infiltrates Immediate cutaneous reactivity to asp. FUMIGATUS Elevated total serum IgE Precipitating antibodies against asp. FUMIGATUS Peripheral eosinophilia Elevated serum IgE and IgG to asp. FUMIGATUS Central/proximal bronchietasis with normal tapering of distal bronchi
    8 : Minor Criteria Expectoration of golden brown sputum plugs Positive sputum culture for ASPERGILLUS species Late (ARTHUS type) skin reactivity to asp.FUMIGATUS
    9 : Radiological Changes In ABPA Transient changes Perihilar infiltrates simulating adenopathy. Air fluid levels from dilated central bronchi filled with fluid and debris. Massive consolidation-unilateral or bilateral. Radiologic infiltrates. “Tooth paste” shadows due to mucoid impactions in dilated bronchi. “Gloved finger” shadows from distally occluded bronchi filled with secretions. “Tram line” shadows representing edema of bronchial walls. Collapse of a lobe or segment.
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