Table 2 Diagnostic criteria for ABPA used for the five cases
Diagnostic criteria for ABPA proposed by the ISHAM working group | Diagnostic criteria for ABPA/ABPM proposed by Asano et al.18 | |||||
|---|---|---|---|---|---|---|
Obligatory criteria | Minor criteria | |||||
Elevated Aspergillus-specific IgE level (> 0.35 kUA/L) | Elevated serum total IgE level (> 1000 IU/mL or simply elevated if all other criteria are met) | Precipitating antibodies or IgG antibodies against Aspergillus | Radiographic findings consistent with ABPA* | Peripheral blood eosinophilia (≥ 500 cells/mm3) | Definite ABPA: ≥ 6 criteria met Probable ABPA: ≥ 5 criteria met | |
Case 1 70 years old | Yes (8.05 kU/L) | No (791 kU/L) | Positive for Aspergillus fumigatus precipitins (4 precipitin bands) | Total left lung collapse on X-ray | No (210/mm3) | Previous asthma-like symptoms Elevated total serum IgE level Specific IgE for filamentous fungi † Presence of specific IgG for filamentous fungi † Filamentous fungal growth in cultures † Presence of mucus plugs in central bronchi, based on bronchoscopy |
Case 2 74 years old | Yes (62.6 kU/L) | Yes (3364 kU/L) | Positive for Aspergillus-specific IgG (94 kUA/L) | Total left lung collapse, central bronchiectasis and presence of mucus plugs in the central bronchi on CT | Yes (2500/mm3) | Peripheral blood eosinophilia (> 500 cells/mm3) Elevated total serum IgE level Immediate cutaneous hypersensitivity and specific IgE for filamentous fungi † Presence of specific IgG for filamentous fungi † Filamentous fungal growth in cultures † Presence of mucus plugs in central bronchi, based on CT/bronchoscopy |
Case 3 73 years old | Yes (10.3 kU/L) | No (406 kU/L) | Negative | Total left lung collapse, no high-attenuation mucus plug or central bronchiectasis in the contralateral lung | Yes (800/mm3) | Current or previous asthma-like symptoms Peripheral blood eosinophilia (> 500 cells/mm3) Specific IgE for filamentous fungi † Presence of fungal hyphae in bronchial mucus plugs Presence of mucus plugs in central bronchi, based on CT/bronchoscopy and mucus plug expectoration history |
Case 4 72 years old | Yes (56.6 kU/L) | Yes (2442 kU/L) | Positive | Complete atelectasis of the left lung, tram-track opacities in the right lower field | No** | Elevated total serum IgE level Specific IgE for filamentous fungi † Presence of specific IgG for filamentous fungi † Filamentous fungal growth in endoscopic cultures † Presence of mucus plugs in central bronchi, based on bronchoscopy |
Case 5 81 years old | Yes (71.5 kUA/L) | Yes (2464 kU/L) | Negative | Right lung atelectasis on CT, no other findings consistent with ABPA | Yes (1009/mm3) | Current or previous asthma-like symptoms Peripheral blood eosinophilia (> 500 cells/mm3) Elevated total serum IgE level Specific IgE for filamentous fungi † Filamentous fungal growth in cultures † Presence of mucus plugs in central bronchi, based on bronchoscopy |