Differential diagnosis is carried out with bacterial pneumonia, carcinoma, tuberculosis, cystic fibrosis, exogenous allergic bronchioloalveolitis, Leffler’s syndrome, candidiasis. Bronchopulmonary allergic aspergillosis also needs to be differentiated with other types of respiratory diseases caused by Aspergillus: aspergilloma, aspergillosis bronchial asthma, invasive septicemic aspergillosis.
Aspergilloma is formed mainly in places of previous anatomical disorders. In these cases, the mycelium of the fungus grows inside the already formed caverns, bronchiectasis, or in areas of damaged lung tissue, neoplasm. Typically, patients with such diseases do not have atopy. Skin tests on A. fumigatus are negative in 80% of the examined, the total level of immunoglobulin E is normal, antibodies related to immunoglobulin E are not detected, the precipitins of the immunoglobulin Q class are easily detected. After resection of the lung area with aspergilloma, the level of precipitating antibodies usually decreases and after a few months they are not detected. No evidence of specific cytophilic antibodies was found. Aspergilloma is sometimes found with common symptoms. In these cases, cytophilic antibodies of subclasses of immunoglobulin G and immunoglobulin E were found, as in bronchopulmonary allergic aspergillosis.
Exogenous allergic bronchioloalveolitis caused by A. fumigatus is very rare; alveolitis due to A. clavatus is uniquely well known. Fungi of the genus Aspergillus can cause bronchial asthma mediated by immunoglobulin E.
Invasive septicemic aspergillosis is often a systemic process. It occurs exclusively in individuals with primary immunodeficiency diseases or severe immunological deficiency secondary, due to either severe illness (leukemia, sarcoidosis), or immunosuppressive therapy. Invasive aspergillosis is observed in patients receiving high doses of immunosuppressants in the treatment of tumors or organ transplants, in the treatment of high doses of glucocorticosteroid drugs, radiation. In the clinic of the disease, pneumonia, mycotic abscesses, chronic granulomas are observed. In some cases, precipitating antibodies to A. fumigatus can be detected, however, immunological tests may be negative under conditions of immunosuppression.
Treatment of bronchopulmonary allergic aspergillosis
The goal of treatment is to break the vicious cycle of constantly increasing the amount of antigenic material as a result of the growth of the fungus in the lumen of the bronchi. Important early and vigorous treatment to prevent severe changes in the lungs. Methods aimed at eliminating antigen from the respiratory tract are ineffective, since it is very difficult to release damaged bronchi from the fungus. The main treatment is systemic glucocorticosteroid therapy in high doses (up to 100 mg per day in the equivalent of prednisone).
Glucocorticosteroid drugs, reducing allergic inflammation, mucus secretion and eliminating airway obstruction, contribute to more efficient secretion of the fungus. Treatment lasts two to three months, if necessary – longer. Inhaled steroids are not effective and do not prevent recurrence of infiltrates. Antimycotic agents are used: natamycin in the form of an aerosol of 2.5 mg in a 2.5% suspension two to three times a day in combination with nystatin (3 LLC LLC – 4 LLC LLC ED inside and in the form of an aerosol). With concomitant bacterial infection, antibiotics are prescribed in combination with anti-allergic therapy. Specific immunotherapy is not recommended, since with subcutaneous injections of antigen extract, pronounced local (Arthus phenomenon) and systemic reactions are possible. Intal well prevents immediate and delayed bronchospastic responses to an antigen (provocative test), but information about the effectiveness of its regular therapeutic use is contradictory. In some cases, mucolytic aerosols (N-acetylcysteine) are used, but their purpose is limited by the possible development of allergic reactions.
Prevention of bronchopulmonary allergic aspergillosis
Prevention consists in preventing the inhalation of air containing high concentrations of A. fumigatus spores (in the locations of compost, rotting organic matter, grain storage).