Allergic bronchopulmonary aspergillosis:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1998
|
| Series: | Immunology and allergy clinics of North America
18,3 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XV S., S. 471 - 715 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Allergic bronchopulmonary aspergillosis |c Viswanath P. Kurup ..., guest eds. |
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CONTENTS
Preface xiii
Viswanath P. Kurup and Andrea J. Apter
Allergic Bronchopulmonary Aspergillosis: A Historical
Perspective 471
Roy Patterson
Allergic bronchopulmonary aspergillosis (ABPA) was identified
in 1952, and in the second half of the century it was defined
clinically, radiographically, and immunologically. It is a complex
disease that may slowly progress to destructive lung disease if
not diagnosed and treated. The evolution of the clinical patterns
of ABPA, classification, seroanalysis, radiographic studies, and
immunopathogenesis are reviewed. ABPA in some cases of cystic
fibrosis is discussed. The variants of ABPA, termed allergic bron¬
chopulmonary mycosis, are briefly reviewed.
Allergic Bronchopulmonary Aspergillosis: Clinical
Perspectives 479
Basil Varkey
This article provides clinical perspectives of ABPA, a disease that
presents as asthma and is caused by hypersensitivity to Aspergil
lus antigens in the bronchi. Criteria to diagnose ABPA are based
on clinical, radiographic, and laboratory features that now em¬
phasize serologic tests that can detect the disease before irrevers¬
ible damage to bronchi and lungs occurs. These criteria are criti¬
cally examined, and their variability at presentation and at
various stages during the course of the disease are pointed out.
An algorithmic approach to diagnose ABPA is presented; it is
grounded on clinical presentation and is built on broad use of
IMMUNOLOGY AND ALLERGY CLINICS OF NORTH AMERICA
VOLUME 18 • NUMBER 3 • AUGUST 1998 vii
screening tests, selective use of serologic tests, and computed
tomography. Pathogenesis, pathology, stages of the disease, and
differential diagnoses of ABPA are also briefly reviewed.
The Association of Allergic Bronchopulmonary
Aspergillosis and Cystic Fibrosis 503
Howard J. Schwartz
The colonization of Aspergilhis fumigatus in the lungs of patients
with cystic fibrosis (CF) may lead to immunologic sensitization
or development of ABPA. Appropriate early diagnosis and treat¬
ment of ABPA in patients with CF are essential because these
patients have a tendency to develop severe airway diseases. The
most important problem involved with immunologic diagnosis is
the lack of pure relevant antigens from Aspergillus. With the
advent of a number of recombinant allergens or antigens, the
diagnosis eventually may be more accurate, leading to better
patient care. The role of genetic predisposition, underlying dis¬
ease, and Aspergillus colonization in the pathophysiology of ABPA
in CF are discussed.
Radiologic Aspects of Allergic Bronchopulmonary
Aspergillosis 509
Harry H. Chen
The radiology of ABPA has varied presentations. The specific
radiologic criterion for ABPA is central bronchiectasis, which
manifests in specific radiographic findings, predominantly in the
upper lobes (including the ring shadow, parallel line shadow,
air fluid level in a dilated bronchus, and the gloved finger
shadow). Because many of the findings are transient, the appear¬
ance of the chest radiograph may change during serial radiogra¬
phy. High resolution computerized tomography is used to con¬
firm chest radiographic findings and to evaluate for the presence
of central bronchiectasis. In addition to substantiating the diagno¬
sis of ABPA, radiography is used to stage the disease.
Immunodiagnosis of Allergic Bronchopulmonary
Aspergillosis 525
P. Usha Sarma, Banani Banerjee, Nivedita Bir, and
Viswanath P. Kurup
Detection of Aspergillus specidc serum antibodies aids in the diag¬
nosis of ABPA. The antigens of A. fumigatus, the fungus predomi¬
nantly implicated in ABPA, are highly visible and consist of a
heterogeneous mixture of proteins, carbohydrates, and glycopro
teins. With recent advancement in bioseparation, hybridoma, and
molecular biology techniques, well characterized and purified an¬
tigens of A. fumigatus have been obtained. The use of these stan¬
dardized antigens may be an aid in increasing the sensitivity and
specificity of immunodiagnosis in ABPA.
Viii CONTENTS
Taxonomy and Ecology of Aspergillus Species Associated
with Colonizing Infections of the Respiratory Tract 549
Richard C. Summerbell
Seven species in (or with anamorphs in) the genus Aspergillus are
significant or emerging agents of respiratory and sinus coloniza¬
tions. They are A. fumigatus, Aspergillus flavus, Aspergillus terreus,
Aspergillus nidulans, Aspergillus niger, Aspergillus ochraceus, and
Neosartorya pseudofischeri. Isolation and correct identification and
ecologic understanding of these species assists in studies of epide¬
miology and pathogenesis.
Cell Mediated Immunity in Allergic Bronchopulmonary
Aspergillosis 575
Alan P. Knutsen, Bela Chauhan, and Raymond G. Slavin
The pathogenesis of ABPA is characterized by a heightened Th2
CD4+ autocrine late phase allergic inflammatory response to A.
fumigatus allergens in the bronchial airway of patients with atopic
asthma and patients with CF. In addition, T cel) responses to A.
fumigatus allergens are HLA DR2 and DR5 and TCR V restricted
in ABPA. The underlying susceptibility to develop ABPA versus
an asthmatic allergic response to A. fumigatus allergens, however,
is not understood.
Molecular Biology of Aspergillus Allergens 601
Banani Banerjee and Viswanath P. Kurup
The unavailability of standardized and reproducible allergenic
extracts is the major limitation in the immunodiagnosis of ABPA.
Through molecular cloning and expression of several A. fumigatus
allergens, it may be possible to obtain well defined A. fumigatus
allergens in large quantities for use in diagnosis. Two recombinant
A. fumigatus allergens, Asp f 1 and Asp f 2, showed specific IgE
binding in patients with ABPA comparable with their native
counterparts. Over 12 recombinant A. fumigatus allergens have
been identified and characterized; these can be used as a stan¬
dardized allergenic preparation. Knowledge of the primary struc¬
ture of these allergens facilitates the identification of immuno
dominant T and B cell epitopes, and may be used to unravel the
structure function relationship of these allergens in relation to
immune modulation and intervention of the disease.
Inflammatory Cells and Airway Defense Against
Aspergillus Fumigatus 619
Henk F. Kauffman and J.F.C. Tomee
The authors offer a summary of the attack strategies of A. fumiga¬
tus and interactions with the airway defense system. The possible
role of proteolytic enzymes from Aspergillus in the inflammatory
CONTENTS ix
response of the airways is also discussed. Evidence is given for
the in vivo production of these proteolytic enzymes in patients
with ABPA and aspergilloma. The authors also describe the role
of epithelial attack by proteolytic enzymes, the induction of a
first wave of chemokines, the succeeding Th2 type inflammatory
response in atopic patients, and the role of eosinophils in the
continuation of this inflammatory cycle. Possibilities for inhibition
of this continuous cycle of inflammation, followed by the resolu¬
tion of ABPA, are discussed.
Epidemiology of Allergic Bronchopulmonary Aspergillosis 641
Harold S. Novey
Despite worldwide reports, ABPA has not attained inclusion into
the International Classification of Diseases, making epidemiologi
cal data difficult to gather. Lack of uniform diagnostic standards
has also impeded the collection of accurate prevalence rates. Best
estimates obtained from literature searches and surveys indicate
less than a 1% prevalence in asthma and about a 7% prevalence
in CF for ABPA. Mortality rates appear to be exceedingly low. A
perceived decline of patients with ABPA under specialist supervi¬
sion suggests a decrease in new case discovery.
Therapy of Allergic Bronchopulmonary Aspergillosis 655
Jordan N. Fink
ABPA is a destructive pulmonary disease with immunologic in¬
flammation as its basis. Underlying asthma is often present. Treat¬
ment of ABPA should be aimed at control of asthma by immuno¬
logic and pharmacologic means. In addition, control of the
progressive inflammatory process of ABPA by (often long term)
use of corticosteroids is appropriate.
Animal Models of Allergic Bronchopulmonary
Aspergillosis 661
Gabriele Griinig, David B. Corry, Robert L. Coffman,
Donna M. Rennick, and Viswanath P. Kurup
Animal models of ABPA provide an intriguing insight into dis¬
ease pathogenesis across various species. In the mouse, the avail¬
ability of gene targeted animals allows for a detailed dissection
of critical cells and cytokines that mediate immunopathology. T
cells are the central effectors that ultimately induce lung pathol¬
ogy and airway hyperreactivity in murine ABPA.
Cytokines in Allergic Bronchopulmonary Aspergillosis 681
Pazhayannur S. Murali, Paul A. Greenberger, and
Viswanath P. Kurup
The role of cytokines in the regulation of immune responses and
the pathogenesis of ABPA is not fully understood. The Aspergillus
X CONTENTS
specific circulation IgE and significant eosinophilia led to the
assumption that ABPA is a Th2 mediated disease, which was
proved by the enhanced presence of interleukin 4 (IL 4) and IL
5 in these patients. Administration of anti IL 4 and anti IL 5
antibodies down regulated the Th2 responses in murine models
of APBA. This conclusion was further supported by studies with
the gene knockout murine model of ABPA. Understanding the
role of cytokines in ABPA and in murine models may shed light
on the immunopathogenesis of the disease, which may lead to
definitive diagnosis and better patient care.
Allergic Fungal Sinusitis 695
David R. Nash and Philip Fireman
Allergic fungal sinusitis is a form of fungal sinusitis that clinically
and histopathologically resembles ABPA. It is the most recently
described and probably least understood fungal sinus disease.
Allergic fungal sinusitis appears to be the cause in 5% to 10% of
patients with chronic sinusitis. Failure to recognize and diagnose
allergic fungal sinusitis is common and is related to the lack of
widely accepted diagnostic criteria and lack of awareness by
clinicians.
Index 711
Subscription Information Inside back cover
CONTENTS Xi
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| spelling | Allergic bronchopulmonary aspergillosis Viswanath P. Kurup ..., guest eds. Philadelphia [u.a.] Saunders 1998 XV S., S. 471 - 715 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Immunology and allergy clinics of North America 18,3 Ademhalingsorganen gtt Allergie gtt Aspergillose gtt Aspergillosis, Allergic Bronchopulmonary Allergisches Asthma (DE-588)4275602-9 gnd rswk-swf Aspergillose (DE-588)4124572-6 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Aspergillose (DE-588)4124572-6 s Allergisches Asthma (DE-588)4275602-9 s DE-604 Kurup, Viswanath P. Sonstige oth Immunology and allergy clinics of North America 18,3 (DE-604)BV000645505 18,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008204309&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Allergic bronchopulmonary aspergillosis Immunology and allergy clinics of North America Ademhalingsorganen gtt Allergie gtt Aspergillose gtt Aspergillosis, Allergic Bronchopulmonary Allergisches Asthma (DE-588)4275602-9 gnd Aspergillose (DE-588)4124572-6 gnd |
| subject_GND | (DE-588)4275602-9 (DE-588)4124572-6 (DE-588)4143413-4 |
| title | Allergic bronchopulmonary aspergillosis |
| title_auth | Allergic bronchopulmonary aspergillosis |
| title_exact_search | Allergic bronchopulmonary aspergillosis |
| title_full | Allergic bronchopulmonary aspergillosis Viswanath P. Kurup ..., guest eds. |
| title_fullStr | Allergic bronchopulmonary aspergillosis Viswanath P. Kurup ..., guest eds. |
| title_full_unstemmed | Allergic bronchopulmonary aspergillosis Viswanath P. Kurup ..., guest eds. |
| title_short | Allergic bronchopulmonary aspergillosis |
| title_sort | allergic bronchopulmonary aspergillosis |
| topic | Ademhalingsorganen gtt Allergie gtt Aspergillose gtt Aspergillosis, Allergic Bronchopulmonary Allergisches Asthma (DE-588)4275602-9 gnd Aspergillose (DE-588)4124572-6 gnd |
| topic_facet | Ademhalingsorganen Allergie Aspergillose Aspergillosis, Allergic Bronchopulmonary Allergisches Asthma Aufsatzsammlung |
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