A retrospective study of patients with a delayed diagnosis of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis

This study was designed to aid health care providers in better understanding the need for earlier recognition of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis (ABPA/ABPM). Patients with a confirmed diagnosis of ABPA/ABPM after evaluation in the Department of Respiratory Medicine of Zhongshan Hospital affiliated to Fudan University between March 2003 and January 2013 were analyzed retrospectively. Clinical signs and symptoms, previous diagnoses and potential diagnostic errors, serologic tests and chest computed tomography (CT) were reviewed and compiled. Seventy patients were diagnosed with ABPA/ABPM in which 52 were misdiagnosed or underdiagnosed. The median total serum IgE level was 2574 IU/mL, ranging from 338 to 31527 IU/mL. Fifty-eight of the 70 patients were tested for specific IgE (sp-IgE) in which 57 were positive to Aspergillus fumigatus and 48 were positive to Penicillium. Twelve of the 70 patients did not undergo sp-IgE testing but allergy skin test, and all were positive to A. fumigatus. The two most common abnormalities found on chest CT exams were central bronchiectasis (CB) and mucus plugs in 48 and 20 patients, respectively. The time from first hospital visit to confirmation of diagnosis for ABPA/ABPM-CB (48/70) was longer than that of ABPA/ABPM-seropositive type (S; 22/70; 30.8 ± 9.81 m versus 9.3 ± 3.55 m; p = 0.044). Prior diagnoses antecedent to our diagnostic conformation included 13 patients with bronchial asthma, 12 with bronchiectasis, and 19 with pneumonia. Only 18 patients were correctly first diagnosed with ABPA/ABPM. ABPA/ABPM is not an uncommon complication accompanying underlying chronic diseases, most notably bronchial asthma and cystic fibrosis. Patients who present with poorly controlled disease, especially with recurrent pulmonary infiltrates, demand the attention of a specialist, the sooner the better to minimize the likelihood of more severe, persistent, and ultimately irreversible pathological changes in large airways. Early treatment of oral corticosteroid with or without antifungal therapy can improve the prognosis. Early testing for ABPA/ABPM along with careful ongoing follow-up is imperative and necessary to prevent or forestall significant future morbidity.