Pulmonary Immunology
Lourdes R. Laraya-Cuasay, Walter T. Hughes in Interstitial Lung Diseases in Children, 2019
Anaphylactic (type I) or immediate hypersensitivity reactions result from antigen binding to preformed IgE antibodies attached to the surface of the mast cell or the basophil. Activation of the mast cell or basophil cause the release of mediators (e.g., histamine) with the production of clinical symptoms such as wheezing, nasal congestion, or vascular collapse. Allergic bronchopulmonary aspergillosis is a disorder typically seen in patients with bronchial asthma. It is characterized by wheezing, low grade fever, eosinophilia, and expectoration of mucus plugs. The airways are colonized by aspergillus and diffusion of the antigen across the mucosa results in specific IgE and IgG being produced. Pathogenesis of this disorder probably involves both immediate (type I) and immune complex (type III) mechanisms. In an experimental model in monkeys it has been shown by Slavin et al. that both IgE and IgG antibody are required for the disease process to develop. Possibly deposition of IgG-immune complexes is facilitated by IgE antibody.31
Selected Human Pathogenic Fungi
Rajendra Prasad, Mahmoud A. Ghannoum in Lipids of Pathogenic Fungi, 2017
Aspergillus species are resistant to most azole antifungals, except itraconazole, making amphotericin B the drug of choice for invasive disease, even though varying resistance to amphotericin B also occurs. Neutropenic patients, with suspected or documented aspergillosis, are initially prescribed high doses of amphotericin B, and therapy is continued for a long time. 5-FC is occasionally used in combination with amphotericin B, but no prospective studies have been done as yet to document efficacy. Despite appropriate therapy, mortality is high in neutropenic patients unless the neutropenia resolves. Surgery plays a prominent role in the treatment of some Aspergillus infections, especially in sinus disease, endocarditis and brain abscess. Asymptomatic aspergillomas may be followed without therapy because of the low incidence of invasion, but may require surgical removal, if significant hemoptysis occurs. Allergic bronchopulmonary aspergillosis, in general, does not require antifungal therapy, but tends to respond to systemic glucocorticoids.
Invasive Mold Infections
Johan A. Maertens, Kieren A. Marr in Diagnosis of Fungal Infections, 2007
Antibody tests for Aspergillus are commercially available. However, they lack enough specificity and sensitivity: a positive result does not distinguish between past and active infection, or between colonization and invasive disease. Furthermore, a negative result does not rule out invasive disease, since the majority of patients at risk are unable to mount an effective antibody response. Antibody tests are, however, useful in the diagnosis of allergic bronchopulmonary aspergillosis and aspergilloma.
The role of precision medicine in bronchiectasis: emerging data and clinical implications
Published in Expert Review of Respiratory Medicine, 2023
Grace Oscullo, David de la Rosa, Marta Garcia Clemente, Rosa Giron, Rafael Golpe, Luis Máiz, Miguel Angel Martinez-Garcia
Bronchiectasis and asthma share functional and clinical features that can lead to the misdiagnosis of both diseases. The association between asthma and bronchiectasis has been well described, especially in uncontrolled or severe asthmatic patients [60]. As with COPD, it is unclear whether there is any causal relationship between bronchiectasis and asthma. Allergic bronchopulmonary aspergillosis is related to the development of both asthma and bronchiectasis, but it is a distinct entity rather than an overlap between the two diseases [61]. It is not clear how asthma can cause bronchiectasis, but eosinophilic inflammation can produce proteolytic enzymes and lead to imbalances between matrix metalloproteinases and tissue inhibitors of metalloproteinases that could cause extracellular matrix degradation and airway damage/dilation [16]. Mucus hypersecretion and plugging could promote chronic bacterial colonization, leading to the vicious circle of infection/inflammation/airway damage. Modifications to airway microbiota may plausibly be associated with a different (neutrophilic) inflammatory phenotype in asthma [62].
Efficacy of nebulized liposomal amphotericin B in the treatment of ABPA in an HIV/HBV co-infected man: Case report and literature review
Published in Journal of Asthma, 2019
Magali Garcia, Gwénaël Le Moal, Jacques Cadranel, France Roblot, Cendrine Godet
A 56-year-old HIV1/HBV co-infected Caucasian man with medical history of asthma and chronic obstructive pulmonary disease (COPD) presented with cough, increasing dyspnea, and general weakness. He had been diagnosed with HIV1/HBV positive 20 years before and treated since 1997. He had a recent CD4 count of 483 cells.mm−3 (17%) and an HIV-1 viral load <50 copies mL−1 under Highly Active Anti Retroviral Therapy (HAART) regimen (darunavir/ritonavir 600/100 mg twice a day, etravirine 200 mg twice a day). He had not been suffering from any opportunistic infection. Laboratory investigations showed an elevated peripheral blood eosinophil count (1.222 cells µL−1), total immunoglobulin (Ig)E (749 IU mL−1), specific anti-Aspergillus fumigatus IgE levels at 28.1 kU.L−1, and the presence of specific anti-A. fumigatus precipitins in the serum (two lines). A thoracic computed tomography (CT) scan revealed left apical condensation with right bronchiectasis associated with bronchocele (Figure 1A). The association of poorly controlled asthma, COPD, and clinical, biological and radiological presentations supported the diagnosis of allergic bronchopulmonary aspergillosis (ABPA).
Comorbidities of sarcoidosis
Published in Annals of Medicine, 2022
Claudio Tana, Marjolein Drent, Hilario Nunes, Vasilis Kouranos, Francesco Cinetto, Naomi T. Jessurun, Paolo Spagnolo
About 37% of patients report haemoptysis at SA-CPA diagnosis, and 40% have weight loss [42]. The categorisation of SA-CPA [43,44] is difficult. However, the most frequent phenotypes of SA-CPA are chronic cavitary pulmonary aspergillosis (60%) and simple aspergilloma (37.8%), which may overlap, while chronic fibrosing pulmonary aspergillosis and subacute invasive aspergillosis are much rarer. Allergic bronchopulmonary aspergillosis has also been exceptionally described [42].