ABPA is not uncommon in children suffering from Asthma or cystic Fibrosis
It is caused by a fungus Aspergillus fumigatus. Other species of Aspergillus may be involved in causation of ABPA.Sometime the clinical manifestations may be due to fungi ,other than Aspergillus and this is the reason this disease entity is now called ABPM-Allergic Bronchopulmonary Mycosis.Aspergillus is found all over the world in the soil, in the stable and where building constructions are going on
When it should be suspected in children -It is suspected in children who is a known asthmatic and on treatment the asthma is well controlled but the child developed the increased symptoms of asthma even on proper treatment with good technique of inhalational medications and good adherence to treatment with no comorbidiy and no recent exposure to known allergen and pollutants.If the child is a known case of Cystic Fibrosis, it is suspected when there is exacerbation inthe form of pulmonary exacerbation even on proper treatment of cystic Fibrosis
Criteria for Diagnosis -There are many guidelines for the diagnosis but the simplest is by International society of human and animal mycology- Essential criteria-1.. Total serum IgE level should be > 1000 IU/ml (in 2014 >500) ,2. Raised Serum specific IgE for Aspergillus Fumigatus or positive skin prick test in a child already diagnosed with Asthma or Cystic Fibrosis
Along with the above two- two of the following three should be present-1.Blood eosinophil >500 cells/cmm, 2.Serum Specific IgG against Aspergillus fumigatus positive 3. Fleeting opacity on chest X-Ray not cleared by antibiotics/chest physiotherapy or Central Bronchiectasis
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