Vida Mortezaee1, Seyed Alireza Mahdaviani2, Mihan Pourabdollah2, Maryam Hassanzad2, Maryam Sadat Mirenayat3, Payam Mehrian4, Naser Behnampour5, Jamshid Yazdani Charati6, Zahra Peirovi4, Somayeh Sharifynia7, Seyedmojtaba Seyedmousavi8,9, Mohammad T Hedayati1,9. 1. Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2. Paediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shaheed Beheshti University of Medical Sciences, Tehran, Iran. 3. Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NIRTLD), Shaheed Beheshti University of Medical Sciences, Tehran, Iran. 4. Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shaheed Beheshti University of Medical Sciences, Tehran, Iran. 5. Department of Biostatistics, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran. 6. Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran. 7. Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Beheshti University of Medical Sciences, Tehran, Iran. 8. Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA. 9. Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Abstract
BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) has been reported in various degrees among patients with persistent allergic asthma (PAA). Currently, there is no gold standard approach for diagnosis of ABPA. OBJECTIVES: In the current study, we aimed the evaluation of three different mainly used algorithms as Rosenberg & Patterson (A), ISHAM Working Group (B) and Greenberger (C) for diagnosis of ABPA in 200 patients with underlying PAA. METHODS: All patients were evaluated using Aspergillus skin prick test (SPTAf), Aspergillus-specific IgE (sIgEAf) and IgG (sIgGAf), total IgE (tIgE), pulmonary function tests, radiological findings and peripheral blood eosinophil count. The prevalence rate of ABPA in PAA patients was estimated by three diagnostic criteria. We used Latent Class Analysis for the evaluation of different diagnostic parameters in different applied ABPA diagnostic algorithms. RESULTS: Aspergillus sensitisation was observed in 30 (15.0%) patients. According to algorithms A, B and C, nine (4.5%), six (3.0%) and 11 (5.5%) of patients were diagnosed with ABPA, respectively. The sensitivity and specificity of criteria B and C were (55.6% and 99.5%) and (100.0% and 98.9%) respectively. sIgEAf and sIgGAf showed the high significant sensitivity. The performance of algorithm A, in terms of sensitivity and specificity, was somewhat better than algorithm B. CONCLUSION: Our study demonstrated that the sensitivity of different diagnostic algorithms could change the prevalence rate of ABPA. We also found that all of three criteria resulted an adequate specificity for ABPA diagnosis. A consensus patterns combining elements of all three criteria may warrant a better diagnostic algorithm.
BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) has been reported in various degrees among patients with persistent allergic asthma (PAA). Currently, there is no gold standard approach for diagnosis of ABPA. OBJECTIVES: In the current study, we aimed the evaluation of three different mainly used algorithms as Rosenberg & Patterson (A), ISHAM Working Group (B) and Greenberger (C) for diagnosis of ABPA in 200 patients with underlying PAA. METHODS: All patients were evaluated using Aspergillus skin prick test (SPTAf), Aspergillus-specific IgE (sIgEAf) and IgG (sIgGAf), total IgE (tIgE), pulmonary function tests, radiological findings and peripheral blood eosinophil count. The prevalence rate of ABPA in PAA patients was estimated by three diagnostic criteria. We used Latent Class Analysis for the evaluation of different diagnostic parameters in different applied ABPA diagnostic algorithms. RESULTS: Aspergillus sensitisation was observed in 30 (15.0%) patients. According to algorithms A, B and C, nine (4.5%), six (3.0%) and 11 (5.5%) of patients were diagnosed with ABPA, respectively. The sensitivity and specificity of criteria B and C were (55.6% and 99.5%) and (100.0% and 98.9%) respectively. sIgEAf and sIgGAf showed the high significant sensitivity. The performance of algorithm A, in terms of sensitivity and specificity, was somewhat better than algorithm B. CONCLUSION: Our study demonstrated that the sensitivity of different diagnostic algorithms could change the prevalence rate of ABPA. We also found that all of three criteria resulted an adequate specificity for ABPA diagnosis. A consensus patterns combining elements of all three criteria may warrant a better diagnostic algorithm.
Authors: Alan P Knutsen; Robert K Bush; Jeffrey G Demain; David W Denning; Anupma Dixit; Abbie Fairs; Paul A Greenberger; Barbara Kariuki; Hirohito Kita; Viswanath P Kurup; Richard B Moss; Robert M Niven; Catherine H Pashley; Raymond G Slavin; Hari M Vijay; Andrew J Wardlaw Journal: J Allergy Clin Immunol Date: 2012-02 Impact factor: 10.793
Authors: R Agarwal; A Chakrabarti; A Shah; D Gupta; J F Meis; R Guleria; R Moss; D W Denning Journal: Clin Exp Allergy Date: 2013-08 Impact factor: 5.018
Authors: Evan Li; Antony Rodriguez; Amber U Luong; David Allen; John Morgan Knight; Farrah Kheradmand; David B Corry Journal: Curr Opin Microbiol Date: 2021-05-27 Impact factor: 7.584