ABPA diagnostic criteria and staging

Skin prick testing (SPT) for Aspergillus fumigatus (AF) as a screening tool

Early diagnosis is responsive to steroids.

CT allows precision in the diagnosis of central bronchiectasis (which is virtually pathognomonic of ABPA) and may enable earlier diagnosis.

But in CF is different
-Thymus- and activation-regulated chemokine (TARC)
-serum total immunoglobulin (Ig)E
-specific Aspergillus fumigatus IgE and IgG
-specific IgE against recombinant A. fumigatus allergens (rAsp f) 1, 3, 4 and 6

Diagnostic accuracy was greater for TARC (93%) than for total IgE (74%), or rAsp f 4 (75%) or f 6 (79%)

Cystic Fibrosis Foundation has proposed a new set of criteria for ABPA diagnosis in cystic fibrosis patients (53):
• clinical deterioration (coughing, wheezing, increased sputum production, exercise intolerance and decrease in pulmonary function);
• immediate hypersensitivity to A. fumigatus (positive skin test or IgE response);
• total serum IgE concentration >1000 kUI/l;
• precipitating antibodies to A. fumigatus;
• abnormal chest roentgenogram (infiltrate, mucus
plugs or unexplained changes compared to previous chest X-ray).

Staging of ABPA