ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS: Clinical Perspectives

Aspergillus, a name derived from the Latin word asperge (to scatter), is a particularly apt one for the fungus that is ubiquitously distributed from the arctics to the tropics. In the early 1800s, avian aspergillosis was recognized, 55 and Sluyter 97 in 1847 published the first description of human aspergillosis. Aspergillus can cause a spectrum of diseases depending on the susceptibility and immune status of the host (Display Box 1) . The first description of allergic bronchopulmonary aspergillosis (ABPA) is credited to Hinson et al in 1952. 35 However, the essential features of the disease and the role of allergy were recognized earlier, although the fungus was not specifically implicated. In 1936, Chobot 13 reported on a boy with atopic eczema in infancy, asthma for 4 years, 6% blood eosinophilia, and abnormal chest radiograph. Later bronchographic studies showed central bronchiectasis with distal bronchial tapering. 12 Watson and Kibler 104 observed that some patients had asthma, bronchiectasis, atopy, eosinophilia in nasal and bronchial secretions and proposed that they had an “allergic type of bronchiectasis.” Ordstrand 68 also described patients with bronchiectasis from an allergic cause. 68 Hinson et al 35 recognized that sensitization of the host to Aspergillus fumigatus in three of their patients “led to pathological changes that warrant a description of the condition as a true bronchopulmonary aspergillosis.” These patients had asthma and “recurrent pyrexial attacks, radiological evidence of recurrent collapse, and consolidation in different areas, purulent sputum-containing plugs and the fungus, and a blood eosinophilia of 1000 per c mm or more.” In the 45 years following this original description of ABPA, the diagnostic criteria for this disease has markedly evolved.