TABLE 1.
Differences between Aspergillus fumigatus colonisation/infection and disease diagnosis and presentation in people with cystic fibrosis [13, 40, 41]
| Colonisation/infection | Disease | |||
| Aspergilloma | Aspergillus bronchitis/bronchiolitis | ABPA | ||
| Diagnostic tests | ||||
| Fungal airway culture | + | +# | + | + |
| Positive RT-PCR | + | + | + | + |
| Serology | ||||
| Total IgE | = | ↑ | =/↑ | ↑↑ |
| A. fumigatus-specific IgE/IgG | = | ↑ | −/↑ | ↑ |
| Galactomannan | − | ↑ | ↑ | ↑ |
| Signs and symptoms | ||||
| Clinical symptoms (productive cough, tenacious sputum, breathlessness or haemoptysis) | = | =/↑ | =/↑ | ↑↑ |
| Pulmonary function | =/↓ | =/↓ | ↓ | ↓ |
| Most common imaging features | ||||
| CR | None/aspecific | Spherical/ovoid mass within a cavity (Monod sign¶) | Bronchopneumonia pattern with alveolar or peribronchial opacity | Transitory alveolar opacities, central mucus plugs (finger in glove sign) |
| CT | BWT, low attenuation regions increased, some mucus plugs | Fungal ball in pre-existing cavity | Bronchiolits pattern with centrilobular nodules, tree-in-bud, BWT, BE, GGO, peribronchial consolidation | Central BE with mucus plugs and mucus with high density (30% of cases, attenuation value >70 HU) |
| MRI | Low intensity regions (representing trapped air or hypoperfusion), T2 hyperintense plugs | Monod sign¶: fungal ball with low T1WI and T2WI signal | BWT, T2WI hyperintense peribronchial consolidation and peripheral mucus plugs (tree-in-bud+) | BWT and T2 hyperintense mucus plugs (in 30% of cases inverted mucus sign, mucus with high T1WI and low T2WI signal) |
−: Absent; +: present; =: normal levels; ↑: increase; ↓: decrease. RT-PCR: real-time polymerase chain reaction; CR: chest radiograph; CT: computed tomography; MRI: magnetic resonance imaging; BWT: bronchial wall thickening; BE: bronchiectasis; GGO: ground glass opacities; HU: Hounsfield Unit; T1WI: T1 weighted images; T2WI: T2 weighted images; ABPA: allergic bronchopulmonary aspergillosis. #: Particularly if no other organisms are isolated from repeated sputum cultures. ¶: Crescentic shape of the mass with surrounding air. +: Mucus impaction in branching bronchioles.