Table 1.
Table summarising proposed criteria for diagnosis for allergic bronchopulmonary aspergillosis and Aspergillus bronchitis in Cystic Fibrosis
| Classic case | Minimal diagnostic criteria |
|---|---|
| Criteria for diagnosis of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis | |
| Acute or subacute clinical deterioration that is not attributable to another aetiology (cough, wheeze, exercise intolerance, exercise-induced asthma, decline in pulmonary function, increased sputum) | Acute or subacute clinical deterioration that is not attributable to another aetiology (cough, wheeze, exercise intolerance, exercise-induced asthma, change in pulmonary function or increased sputum production) |
| A serum total IgE level of > 1,000 IU per ml (2,400 ng/ml) unless patient is receiving systemic steroids (requires retest when steroid treatment is discontinued) | A serum total IgE level of > 500 IU per ml (> 1,200 ng/ml). If ABPA is suspected and the total IgE level is 200–500 IU per mL, repeat testing one to three months is recommended. If patient is taking steroids, repeat when steroid treatment is discontinued |
| Presence of IgE antibodies to A. fumigatus in vitro or immediate cutaneous hypersensitivity to aspergillus | Immediate cutaneous reactivity to A. fumigatus (prick test wheal > 3 mm with surrounding erythema, off systemic antihistamines) or in vitro demonstration of IgE antibody to A. Fumigatus |
| Precipitating antibodies to A. fumigatus or serum IgG antibody to A. Fumigatus | One of the following: |
| Precipitating antibodies to A. fumigatus or serum IgG antibody to A. fumigatus | |
| New or recent infiltrates ( or mucus plugging) on chest radiology or computed tomography that do not respond to antibodies and standard physiotherapy | |
| New or recent abnormalities on chest radiography (infiltrates or mucus plugging) or computed tomography (bronchiectasis) that do not respond to antibiotics and standard physiotherapy | |
| Criteria for Aspergillus Bronchitis | |
| Microbiology | Repeat sputum culture for Aspergillus sp |
| Positive sputum galactomannan | |
| Symptoms | Chronic (> 4 weeks) pulmonary symptoms (chronic productive cough, tenacious mucus production, dyspnoea and difficult airway clearance) |
| Absence of semi-invasive disease | Absence of significant tissue invasion and lung parenchymal destruction (e.g. cavity formation) |
|
Serology (Bronchoscopy findings) |
Aspergillus IgG antibody detectable in serum |
| Negative IgE (lack of allergic response) | |
| Mucoid impaction, thick tenacious sputum with bronchial plugging, bronchial erythema (touch bleeding) and/or ulceration | |
| Superficial invasion of mucosa by Aspergillus hyphae | |