Muhammad Ashraf, Arif Zaidi, Raheel Hussain, Mazhar Faiz Alam.
Allergic Bronchopulmonary Aspergillosis (ABPA) commonly misdiagnosed as pulmonary tuberculosis.
Pak J Chest Med Jan ;13(3):3-8.

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA), a syndrome associated with asthma, manifests with transient pulmonary infiltrates and eosinophilia and can progress to severe proximal bronchiectasis, and pulmonary fibrosis. Early recognition and treatment should favorably influence these complications. OBJECTIVES: To study the clinical and radiologic features of the patients of ABPA, with emphasis on their previous diagnosis and treatment especially of tuberculosis. DESIGN AND SETTING: Prospective recruitment of all the patients of ABPA, diagnosed at the Pulmonology unit QAMC / Bahawal Victoria Hospital Bahawalpur during 2005-06. PATIENTS AND METHODS: We studied the clinical and the radiological features of ABPA, with special emphasis on previous diagnosis and treatment of tuberculosis. Standardized data collection of symptoms, bacteriology, and review of radiology by two readers blind to the clinical data was done. RESULTS: There were 672 patients of ABPA. Demographic analysis showed a preponderance of males, young patients (less than 35 years old), farming and rural communities. 90% patients were asthmatic with long history of wheezing. Most common symptoms were breathlessness (93 %), cough (96 %), expectoration (78 %), fever (92 %), chest pain (82 %) and hemoptysis (48 %). Forty five percent patients had associated nasal symptoms. More than 60 % patients were erroneously diagnosed and treated as pulmonary tuberculosis while about 30 % of them took two or more courses of anti- tuberculous treatment. CONCLUSIONS: ABPA is more prevalent than previously appreciated. Its clinical presentation is similar to pulmonary tuberculosis hence most cases of ABPA are misdiagnosed as pulmonary tuberculosis; delay in diagnosis and treatment not only predisposes them to complications like bronchiectasis and fibrosis but also to potentially toxic anti–tuberculous therapy. For the clinician, it is imperative to consider the diagnosis in asthmatic patients with radiographic infiltrates and/or bronchiectasis.

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