diagnostic criteria - ABPA

Q; Asthma or cystic fibrosis (CF) should be present for the diagnosis of Allergic bronchopulmonary aspergillosis (ABPA)?

A) True

B) False

Answer: A

The diagnostic criteria proposed by the International Society for Human and Animal Mycology (ISHAM) working group for ABPA that simplify prior diagnostic schema has following three criteria:

Predisposing conditions (one must be present):

• Asthma
• Cystic fibrosis (CF)

Obligatory criteria (both must be present):

• Detectable serum IgE levels against Aspergillus fumigatus or Aspergillus skin test positivity
• Elevated total serum IgE concentration (typically >1000 IU/mL (if the patient meets all other criteria, an IgE value <1000 IU/mL may be acceptable, especially if serum Aspergillus fumigatus-specific IgG levels are >27 mg/L)

Other criteria (at least two must be present):

• Precipitating serum antibodies to A. fumigatus or elevated Aspergillus fumigatus-specific IgG levels (>27 mg/L)
• Radiographic pulmonary opacities consistent with ABPA (see 'Imaging' above)
• Total eosinophil count >500 cells/microL in glucocorticoid-naïve patients (may be historical)

  

  

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Reference:

  

Agarwal R, Sehgal IS, Dhooria S, Aggarwal AN. Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis. Expert Rev Respir Med 2016; 10:1317.