Allergic Bronchopulmonary Aspergillosis due to Aspergillus niger. Report of two cases in Greece and review of the literature
More details
Hide details
2nd Pulmonary Department, “Attikon” University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
6th Pulmonary Department, Athens Chest Hospital, Greece
2nd Department of Internal Medicine, “ATTIKON” General University Hospital, Medical School, University of Athens, Greece
First Department of Pediatrics, Athens Medical School, Aghia Sophia Children’s Hospital, Athens, Greece
7th Pulmonary Department and Asthma Center, Athens Chest Hospital, Greece
Spyros A. Papiris   

2nd Pulmonary Medicine Department, “Attikon” University Hospital, 1 Rimini Street, 12462, Haidari
Pneumon 2014;27(4):336–339
Two cases of allergic bronchopulmonary aspergillosis (ABPA) are reported. Both patients presented severe asthma, central bronchiectasis and fleeting infiltrates on computed tomography of the chest, immediate cutaneous reactivity to Aspergillus spp, elevated total serum IgE and elevated IgG and/or IgM Aspergillus antibodies. Bronchoalveolar lavage culture documented A. niger, a very rarely encountered fungus species in this entity. Although the incidence and rate of hospitalization for asthma have increased the last decades in Greece and skin sensitization to Aspergillus is described in 5% of greek atopic patients, ABPA is scarcely reported. Untreated ABPA results in recurrent exacerbations of airway inflammation, persistent asthma and can progress to advanced fibrotic changes. Therefore high clinical suspicion, early diagnosis and timely treatment and follow-up are considered significant in the course of this rare and underdiagnosed entity.
Ab: Antibodies, A. niger: Aspergillus niger, DLCOSB: Diffusing capacity of the lung for carbon monoxide Single breath technique, HCO3: Bicarbonate, A. fumigates: Aspergillus fumigatus
All the authors declare that they do not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.
Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med 1977; 86:405-14.
Patterson KC, Strek ME. Diagnosis and treatment of pulmonary aspergillosis syndromes. Chest 2014;146:1358-68.
Becker JW, Burke W, McDonald G, Greenberger PA, Henderson WR, Aitken ML. Prevalence of allergic bronchopulmonary aspergillosis and atopy in adult patients with cystic fibrosis. Chest 1996; 109:1536-40.
deShazo RD, Chapin K, Swain RE. Fungal sinusitis. N Engl J Med 1997; 337:254-9.
Eppinger TM, Greenberger PA, White DA, Brown AE, Cunningham-Rundles C. Sensitization to Aspergillus species in the congenital neutrophil disorders chronic granulomatous disease and hyper -IgE syndrome. J Allergy Clin Immunol 1999; 104:1265-72.
Greenberger PA, Bush RK, Demain JG, Luong A, Slavin RG, Knutsen AP. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract 2014; 2:703-8.
Wark P. Pathogenesis of allergic bronchopulmonary aspergillosis and an evidence-based review in azoles in treatment. Respiratory Medicine 2004; 98:915-23.
Staib F. Ecological and epidemiological aspects of aspergilli pathogenic for man and animal in Berlin (West). Zentralbl Bakteriol 1984; 257:240-5.
Papavassiliou JT, Bartzokas CA. The atmospheric fungal flora of the Athens metropolitan area. Mycopathologia 1975; 57:31-4.
Panagopoulou P, Filioti J, Petrikkos G, et al. Environmental surveillance of filamentous fungi in three tertiary care hospitals in Greece. J Hosp Infect 2002; 52:185-91.
Penalver MC, Casanove M, Martinez JP, Gil ML. Cell wall protein and glycoprotein constituents of Aspergillus fumigatus that bind to polystyrene may be responsible for the cell surface hydrophobicity of the mycelium. Microbiology 1996; 142:1597-604.
Amitani R, Murayama T, Nawada R, Lee WJ, et al. Aspergillus culture filtrates and sputum sols from patients with pulmonary aspergillosis cause damage to human respiratory ciliated epithelium in vitro. Eur Respir J 1995; 8:1681-7.
Kauffman HF, Tomee JF, van de Riet MA, Timmerman AJ, Borger P. Protease dependent activation of epithelial cells by activation of epithelial cells by fungal allergens leads to morphological changes and cytokine production. J Allergy Clin Immunol 2000; 105:1185-93.
Hoshino H, Tagaki S, Kon H, et al. Allergic bronchopulmonary aspergillosis due to Aspergillus niger without bronchial asthma. Respiration 1999; 66: 369-72.
Sharma TN, Gupta PR, Mehrotra AK, Purohit SD, Mangal HN. Aspergilloma with ABPA due to Aspergillus niger. J Assoc Physicians India 1985; 33:748.
Sanchez-Alarcos JMF, Martinez-Cruz R, Ortega L, Calle M, Rodriguez-Hermosa JL, Alvarez-Sala JL. ABPA mimicking bronchogenic cancer. Allergy 2001; 56:80-1.
[No author listed] Worldwide variations in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet 1998; 351:1225-32.
Sichletidis L, Chloros D, Tsiotsios I, et al. The prevalence of allergic asthma and rhinitis in children of Polichni, Thessaloniki. Allergol Immunopathol (Madr) 2004; 32:59-63.
Priftis K, Panagiotopoulou-Gartagani P, Tapratzi-Potamianou P, et al. Hospitalizations for childhood asthma in Athens, Greece, from 1978 to 2000. Pediatr Allergy Immunol 2005; 16:82-5.
Gioulekas D, Damialis A, Papakosta D, Spieksma F, Giouleka P, Patakas D. Allergenic fungi spore records (15 years) and sensitization in patients with respiratory allergy in Thessaloniki-Greece. J Investig Allergol Clin Immunol 2004; 14:225-31.