Download PDF
J Pediatr Infect Dis 2024; 19(03): 182-186
DOI: 10.1055/s-0044-1786379
Original Article

Exploring the Epidemiology and Clinico-Demographic Characteristics of Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis

Javeed Iqbal Bhat
1   Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
,
Shahan Iqbal Zargar
1   Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
,
Mudasir Hamid Bhat
2   Department of Radio Diagnosis, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
,
Zubair Mushtaq Tramboo
1   Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
,
Bashir Ahmad Charoo
1   Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
,
Zubair Ahmad Thoker
3   Department of Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, India
› Author Affiliations Funding The authors have received funding from SKIMS Intramural Grant.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to find the prevalence and clinico-demographic profile of cystic fibrosis (CF) children with allergic bronchopulmonary aspergillosis (ABPA).

Methods A cross-sectional study was conducted at a CF clinic of a tertiary care hospital. Participants included the diagnosed cases of children with CF, of both genders, from 4 to 18 years of age.

Results A total of 61 patients were enrolled. Sixteen patients (26.2%) had Aspergillus fumigatus sensitization—among these, 10 (16.4%) patients fulfilled the minimum diagnostic criteria for ABPA and 6 (9.8%) had A. fumigatus sensitization only. Two patients were below the age of 5 years, while eight patients were more than 6 years old. The female-to-male ratio was 6:4. High attenuated mucus was the specific finding in our study cohort on computed tomography (CT) chest. All patients with ABPA had significantly higher median (interquartile range [IQR]) levels of total IgE, specific IgE, and IgG for A. fumigatus, and total eosinophil count compared to patients without ABPA. There was also a significant decrease in forced exhalation volume in first second (FEV1) values (6 months apart) in ABPA patients.

Conclusion Our study found that ABPA affects 16.4% of our CF population, with 20% of cases occurring in children aged 4 to 5 years. We observed a higher prevalence of ABPA in patients from rural areas. Eosinophilia and serial decline in FEV1 values were observed as potential early markers for ABPA.

Keywords

cystic fibrosis - children - Kashmir - ABPA

Ethical Approval

The study was approved by IEC SKIMS, No: SIMS1131/IEC-SKIMS/2021-49 (dated February 22, 2021).


Authors' Contributions

J.I.B., S.I.Z., and M.H.B. conceived the idea of the study and wrote the manuscript. S.I.Z. and Z.A.T. was involved in sample collection. Z.M.T. was responsible for data analysis. B.A.C. supervised implementation of the study and contributed to the writing of the manuscript. All authors approved the final version of the manuscript, and are accountable for all aspects related to the study.


Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.




Publication History

Received: 17 November 2023

Accepted: 27 March 2024

Article published online:
03 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 O'Sullivan BP, Freedman SD. Cystic fibrosis. Lancet 2009; 373 (9678): 1891-1904
    CrossrefPubMedGoogle Scholar
  • 2 Lyczak JB, Cannon CL, Pier GB. Lung infections associated with cystic fibrosis. Clin Microbiol Rev 2002; 15 (02) 194-222
    CrossrefPubMedGoogle Scholar
  • 3 Lattanzi C, Messina G, Fainardi V, Tripodi MC, Pisi G, Esposito S. Allergic bronchopulmonary aspergillosis in children with cystic fibrosis: an update on the newest diagnostic tools and therapeutic approaches. Pathogens 2020; 9 (09) 716
    CrossrefPubMedGoogle Scholar
  • 4 Janahi IA, Rehman A, Al-Naimi AR. Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Ann Thorac Med 2017; 12 (02) 74-82
    CrossrefPubMedGoogle Scholar
  • 5 Stevens DA, Moss RB, Kurup VP. et al; Participants in the Cystic Fibrosis Foundation Consensus Conference. Allergic bronchopulmonary aspergillosis in cystic fibrosis–state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin Infect Dis 2003; 37 (Suppl. 03) S225-S264
    CrossrefPubMedGoogle Scholar
  • 6 Agarwal R, Sehgal IS, Dhooria S. et al. Allergic bronchopulmonary aspergillosis. Indian J Med Res 2020; 151 (06) 529-549
    CrossrefPubMedGoogle Scholar
  • 7 Sharma VK, Raj D, Xess I, Lodha R, Kabra SK. Prevalence and risk factors for allergic bronchopulmonary aspergillosis in Indian children with cystic fibrosis. Indian Pediatr 2014; 51 (04) 295-297
    CrossrefPubMedGoogle Scholar
  • 8 Fainardi V, Sodini C, Deolmi M. et al. Clinical impact of Aspergillus fumigatus in children with cystic fibrosis. Microorganisms 2022; 10 (04) 739
    CrossrefPubMedGoogle Scholar
  • 9 Hedayati N, Mortezaee V, Mahdaviani SA. et al. Prevalence of specific immunoglobulin E and G against Aspergillus fumigatus in patients with asthma. Curr Med Mycol 2018; 4 (04) 7-11
    PubMedGoogle Scholar
  • 10 Fillaux J, Brémont F, Murris M. et al. Aspergillus sensitization or carriage in cystic fibrosis patients. Pediatr Infect Dis J 2014; 33 (07) 680-686
    CrossrefPubMedGoogle Scholar
  • 11 Sarrafzadeh S, Pourpak Z, Mansoori SD, Fattahi F, Moin M. Allergic bronchopulmonary aspergillosis (ABPA) in asthmatic and cystic fibrosis patients. Int J Infect Dis 2008; 12: e77
    CrossrefPubMedGoogle Scholar
  • 12 Maleki M, Mortezaee V, Hassanzad M. et al. Prevalence of allergic bronchopulmonary aspergillosis in cystic fibrosis patients using two different diagnostic criteria. Eur Ann Allergy Clin Immunol 2020; 52 (03) 104-111
    CrossrefPubMedGoogle Scholar
  • 13 Agarwal R, Gupta D, Aggarwal AN. et al. Clinical spectrum and therapeutic management of allergic bronchopulmonary aspergillosis: a multicenter study from North India. J Asthma 2013; 50 (02) 127-133
    PubMedGoogle Scholar
  • 14 Barbi E, Longo G, Binda S. et al. Allergic bronchopulmonary aspergillosis in infants: a report of two cases. Pediatr Allergy Immunol 2006; 17 (01) 63-65
    PubMedGoogle Scholar
  • 15 Vijayakanthi N, Ravinanthanan M, Rameshkumar K, Prasad HK. Allergic bronchopulmonary aspergillosis in a child less than three years of age. Lung India 2015; 32 (05) 507-510
    PubMedGoogle Scholar
  • 16 Dasgupta A, Ghosh M, Bandyopadhyay A, Ghosh A, Saha S, Sengupta S. Correlation between nutritional status and allergic bronchopulmonary aspergillosis in children with asthma. Indian J Allergy Asthma Immunol 2014; 28 (01) 1-5
    PubMedGoogle Scholar
  • 17 Jubin V, Ranque S, Stremler Le Bel N, Sarles J, Dubus JC. Risk factors for Aspergillus colonization and allergic bronchopulmonary aspergillosis in children with cystic fibrosis. Pediatr Pulmonol 2010; 45 (08) 764-771
    CrossrefPubMedGoogle Scholar
  • 18 Muthu V, Sehgal IS, Agarwal R. High-attenuation mucus: a marker of allergic bronchopulmonary aspergillosis?. J Bras Pneumol 2019; 45 (01) e20180153
    PubMedGoogle Scholar
  • 19 Agarwal R. High attenuation mucoid impaction in allergic bronchopulmonary aspergillosis. World J Radiol 2010; 2 (01) 41-43
    CrossrefPubMedGoogle Scholar
  • 20 Ayub II, Venkatramanan P. High-attenuation mucus in allergic bronchopulmonary aspergillosis. Arch Dis Child 2023; 108 (02) 101-102
    CrossrefPubMedGoogle Scholar
  • 21 Evans PM, O'Connor BJ, Fuller RW, Barnes PJ, Chung KF. Effect of inhaled corticosteroids on peripheral blood eosinophil counts and density profiles in asthma. J Allergy Clin Immunol 1993; 91 (02) 643-650
    CrossrefPubMedGoogle Scholar
  • 22 Agarwal R, Chakrabarti A. Allergic bronchopulmonary aspergillosis: lessons from the past and a glimpse into the future. Expert Rev Respir Med 2011; 5 (06) 787-802
    PubMedGoogle Scholar