Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis

Abstract Background Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examine...

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Autores principales:	Mari Miki, Yuko Ohara, Kazuyuki Tsujino, Takahiro Kawasaki, Tomoki Kuge, Yuji Yamamoto, Takanori Matsuki, Keisuke Miki, Hiroshi Kida
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Aspergillus Eosinophilia Eosinophilic pneumonia Ground-glass opacities Immunoglobulin E Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/599d97d4b46e424c951efe2a28e8783c
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spelling	oai:doaj.org-article:599d97d4b46e424c951efe2a28e8783c2021-11-21T12:39:18ZPulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis10.1186/s13223-021-00624-41710-1492https://doaj.org/article/599d97d4b46e424c951efe2a28e8783c2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13223-021-00624-4https://doaj.org/toc/1710-1492Abstract Background Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows. Methods This retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed. Results Baseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7–18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2–9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse. Conclusions The ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.Mari MikiYuko OharaKazuyuki TsujinoTakahiro KawasakiTomoki KugeYuji YamamotoTakanori MatsukiKeisuke MikiHiroshi KidaBMCarticleAspergillusEosinophiliaEosinophilic pneumoniaGround-glass opacitiesImmunoglobulin EImmunologic diseases. AllergyRC581-607ENAllergy, Asthma & Clinical Immunology, Vol 17, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Aspergillus Eosinophilia Eosinophilic pneumonia Ground-glass opacities Immunoglobulin E Immunologic diseases. Allergy RC581-607
spellingShingle	Aspergillus Eosinophilia Eosinophilic pneumonia Ground-glass opacities Immunoglobulin E Immunologic diseases. Allergy RC581-607 Mari Miki Yuko Ohara Kazuyuki Tsujino Takahiro Kawasaki Tomoki Kuge Yuji Yamamoto Takanori Matsuki Keisuke Miki Hiroshi Kida Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis
description	Abstract Background Allergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows. Methods This retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed. Results Baseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7–18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2–9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse. Conclusions The ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.
format	article
author	Mari Miki Yuko Ohara Kazuyuki Tsujino Takahiro Kawasaki Tomoki Kuge Yuji Yamamoto Takanori Matsuki Keisuke Miki Hiroshi Kida
author_facet	Mari Miki Yuko Ohara Kazuyuki Tsujino Takahiro Kawasaki Tomoki Kuge Yuji Yamamoto Takanori Matsuki Keisuke Miki Hiroshi Kida
author_sort	Mari Miki
title	Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis
title_short	Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis
title_full	Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis
title_fullStr	Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis
title_full_unstemmed	Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis
title_sort	pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis
publisher	BMC
publishDate	2021
url	https://doaj.org/article/599d97d4b46e424c951efe2a28e8783c
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Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis

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