How to distinguish allergic bronchopulmonary aspergillosis from invasive necrotizing aspergillosis?

The Bottom Line: Allergic bronchopulmonary aspergillosisis is generally suspected on clinical grounds; diagnosis is confirmed by radiological and serological testing. Almost every patient has clinical asthma, and patients usually present with episodic wheezing, expectoration of sputum containing brown plugs, pleuritic chest pain, and fever. For chronic necrotizing aspergillosis, patients generally complain of constitutional symptoms such as fever, weight loss of 1–6 months’ duration, malaise, and fatigue, as well as chronic productive cough and haemoptysis, which varies from mild to severe. On occasion, patients may be asymptomatic. Treatment for CNA is best evaluated by following clinical, radiological, serological, and microbiological parameters, including total serum IgE level

Zmeili, O S, and A O OSoubani. “Pulmonary aspergillosis: a clinical update.” QJM 100.6 (2007):317-334.

Aspergillus spp are ubiquitous fungi acquired by inhalation of airborne spores and can cause life threatening infections especially in immunocompromised hosts. Aspergillus spp are commonly isolated from the soil, plant debris, and the indoor environment, including hospitals. Pulmonary disease caused by Aspergillus, mainly A. fumigatus, presents with a spectrum of clinical syndromes in the lung

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