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1/108. Allergic bronchopulmonary aspergillosis caused by aspergillus ochraceus.

    A case with the characteristics of allergic bronchopulmonary aspergillosis is described. The species of Aspergillus involved, A. ochraceus, has not previously been found in this disorder. The organism had antigenic properties distinct from five other species of Aspergillus most commonly associated with allergic bronchopulmonary aspergillosis. The patient had immediate skin test, immunodiffusion, and radioallergosorbent reactivity to the species. Four per cent of 112 serum samples from others suspected of having allergic bronchopulmonary aspergillosis had precipitins to A. ochraceus only. It may be necessary in some cases to prepare and test extracts of the patient's Aspergillus isolate in order to confirm the diagnosis.
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2/108. Hilar adenopathy in allergic bronchopulmonary aspergillosis.

    BACKGROUND: A 20-year-old male student developed allergic bronchopulmonary aspergillosis (ABPA). Computed tomography (CT) of the thorax done to detect central bronchiectasis (CB) for confirmation of diagnosis revealed, in addition, right hilar lymphadenopathy. Hilar adenopathy is thought to be rare in ABPA and has been documented only once before. Because of the finding of hilar adenopathy, the earlier reported patient had to undergo an invasive surgical procedure. OBJECTIVE: To report a case of true hilar adenopathy in ABPA. methods: This is a single case report. Contrast enhanced CT of the thorax was done. serum precipitating antibodies against aspergillus fumigatus were tested using gel diffusion technique, and intradermal testing with antigens of Aspergillus species was performed. Specific IgG antibodies against A. fumigatus and total IgE levels were measured by ELISA. RESULTS: A review of serial chest radiographs over a period of 3 years demonstrated transient pulmonary infiltrates and right hilar prominence. Computed tomography of the thorax revealed right hilar lymphadenopathy along with bilateral central bronchiectasis and patchy infiltrates. Strong bands of precipitins were detected against A. fumigatus. Intradermal testing with antigens of Aspergillus species elicited strong type I (immediate) and type III (Arthus-type) hypersensitivity reactions to A. fumigatus and A. niger. Specific IgG antibodies against A. fumigatus was positive and total IgE level was significantly elevated. Peripheral blood eosinophilia was also detected. CONCLUSIONS: Although extremely rare, ABPA should be considered in the differential diagnosis of hilar adenopathy.
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ranking = 0.71428571428571
keywords = bronchopulmonary
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3/108. Allergic bronchopulmonary aspergillosis due to aspergillus niger without bronchial asthma.

    A 65-year-old woman was admitted to our hospital with a dry cough and pulmonary infiltrates. Chest radiograph and CT revealed mucoid impaction and consolidations. Peripheral blood eosinophilia and elevated serum IgE were observed. aspergillus niger was cultured repeatedly from her sputum, but A. fumigatus was not detected. Immediate skin test and specific IgE (RAST) to Aspergillus antigen were positive. Precipitating antibodies were confirmed against A. niger antigen, but not against A. fumigatus antigen. She had no asthmatic symptoms, and showed no bronchial hyperreactivity to methacholine. Thus, this case was diagnosed as allergic bronchopulmonary aspergillosis (ABPA) without bronchial asthma due to A. niger, an organism rarely found in ABPA. The administration of prednisone improved the symptoms and corrected the abnormal laboratory findings.
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ranking = 0.71428571428571
keywords = bronchopulmonary
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4/108. Severe allergic bronchopulmonary aspergillosis in an infant with cystic fibrosis and her asthmatic father.

    An infant with cystic fibrosis and her asthmatic father were diagnosed as suffering from allergic bronchopulmonary aspergillosis (ABPA). cystic fibrosis was diagnosed in the infant at 6 weeks of age, and gene mutations were W1282X/G542X. She was diagnosed definitively as suffering from ABPA at age 3.5 years, but had suggestive symptoms from age 11 months. This may be the youngest age described to date for ABPA. The child responded well to systemic steroid therapy, but remained steroid-dependent over the next 4 years. Treatment with itraconazole enabled a marked reduction in steroid dosage. The father was an asthmatic, and a heterozygote for the cystic fibrosis transmembrane regulator (CFTR) mutation W1282X. He had a normal sweat test, atopy, and moderate reversible airway obstruction. There was no proven exposure to Aspergillus in the home environment. The importance of considering the diagnosis of ABPA even in infancy, the therapeutic dilemmas, and the possible role of abnormal CFTR function in the development of ABPA are discussed.
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ranking = 0.71428571428571
keywords = bronchopulmonary
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5/108. Two year follow-up of a garbage collector with allergic bronchopulmonary aspergillosis (ABPA).

    BACKGROUND: Separate collection of biodegradable garbage and recyclable waste is expected to become mandatory in some western countries. A growing number of persons engaged in garbage collection and separation might become endangered by high loads of bacteria and fungi. Case history and examination A 29 year old garbage collector involved in emptying so-called biological garbage complained of dyspnea, fever, and flu-like symptoms during work beginning in the summer of 1992. Chest x-ray showed streaky shadows near both hili reaching into the upper regions. IgE- and IgG-antibodies (CAP, Pharmacia, sweden) were strongly positive for aspergillus fumigatus with 90.5 kU/L and 186%, respectively. Total-IgE was also strongly elevated with 5430 kU/L. Bronchial challenge testing with commercially available aspergillus fumigatus extract resulted in an immediate-type asthmatic reaction. Two years later he was still symptomatic and antibodies persisted at lower levels. CONCLUSIONS: Our diagnosis was allergic bronchopulmonary aspergillosis (ABPA) including asthmatic responses as well as hypersensitivity pneumonitis (extrinsic allergic alveolitis) due to exposure to moldy household waste. A growing number of persons engaged in garbage collection and handling are exposed and at risk to develop sensitization to fungi due to exposure to dust of biodegradable waste. Further studies are necessary to show if separate collection of biodegradable waste increases the health risks due to exposure to bacteria and fungi in comparison to waste collection without separation.
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ranking = 0.71428571428571
keywords = bronchopulmonary
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6/108. Allergic bronchopulmonary aspergillosis in two patients with cystic fibrosis.

    Allergic bronchopulmonary aspergillosis (ABPA) is hypersensitivity to aspergillus fumigatus which manifests as episodic wheezing, usually refractory to bronchodilator therapy, with fixed and transient pulmonary infiltrates, central bronchiectasis, blood eosinophilia, elevated serum IgE level, immediate skin reactivity to an A. fumigatus antigen and precipitating antibodies to A. fumigatus. It is an unusual complication of asthma and cystic fibrosis (CF). We present two cystic fibrosis patients with ABPA treated successfully with prednisone and, in Case 1 also with itraconazole. The physician should be alert to the possibility of ABPA whenever CF patients present with the new infiltrates, high serum total IgE and other positive parameters of A. fumigatus sensitization. Treatment with systemic steroids should be started in order to prevent irreversible lung damage.
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ranking = 0.71428571428571
keywords = bronchopulmonary
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7/108. Allergic bronchopulmonary aspergillosis as presenting sign of cystic fibrosis in an elderly man.

    BACKGROUND: Although cystic fibrosis is the most common genetic disorder of children, its heterogeneous spectrum of severity lends itself to underdiagnosis in the older adult patient population where the index of suspicion is not high. methods: We report a 60-year-old Hispanic man with asthma who presented with progressive dyspnea and wheezing unresponsive to inhaled corticosteroid treatment. Additionally, he had clinical findings and a past history suggestive of cystic fibrosis. skin testing, radiography and laboratory studies were completed to evaluate for allergic bronchopulmonary aspergillosis (ABPA) and cystic fibrosis. RESULTS: Test results revealed peripheral eosinophilia and hyper IgE. skin testing to aspergillus fumigatus (Af) was positive. IgG, IgM, and Af specific antibodies were present. High resolution CT scan showed central bronchiectasis. sweat tests were positive on two separate occasions and gene analysis showed our patient to have a positive gene mutation at D127ON/D127ON. CONCLUSION: cystic fibrosis should be suspected in the older adult patient with a compatible clinical presentation.
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ranking = 0.71428571428571
keywords = bronchopulmonary
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8/108. A case of endobronchial aspergilloma.

    pulmonary aspergillosis may be classified under three categories, depending upon whether the host is atopic or immunocompromised: invasive aspergillosis, allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma. However, it is not always possible to effectively categorize this disease. We experienced a case of endobronchial aspergilloma, which was difficult to categorize, in a healthy male patient. The chest X-ray and computed tomography showed an ill-defined nodule mimicking lung cancer. Fiberoptic bronchoscopy revealed an aspergilloma without cavity formation in the left lower laterobasal segmental bronchial orifice. The aspergilloma was removed and the patient's symptoms were relieved. We present this unusual case with a review of the literature.
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ranking = 0.14285714285714
keywords = bronchopulmonary
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9/108. Allergic bronchopulmonary aspergillosis in an hiv-infected individual.

    Aspergilloma and invasive aspergillosis have been reported in hiv-infected individuals. Allergic Bronchopulmonary Aspergillosis (ABPA) is a lung disease marked by a hypersensitivity response to inhaled aspergillus species, most commonly aspergillus fumigatus (Af). This manifestation of Af has previously not been reported in hiv-infected individuals. We report a case of an hiv-infected individual with ABPA who presents with a subacute respiratory illness and new pulmonary infiltrates.
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ranking = 0.57142857142857
keywords = bronchopulmonary
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10/108. Allergic bronchopulmonary aspergillosis with cavitary lesion simulating a lung abscess.

    A 48-year-old female patient was diagnosed as a case of allergic bronchopulmonary aspergillosis (ABPA) on the basis of clinical, immunological and radiological criteria. In addition to central bronchiectasis, computed tomography (CT) of the thorax revealed hilar lymphadenopathy and cavitary lesions simulating a lung abscess, a presentation not described earlier. The patient responded to treatment with corticosteroids and the CT repeated after 14 months of treatment showed complete resolution of the cavitary lesions.
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ranking = 0.71428571428571
keywords = bronchopulmonary
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