43 下列何者並非allergic bronchopulmonary aspergillosis之主要診斷的要件（main diagnosis criteria）？

Bronchial asthma Peripheral eosinophilia Central bronchiectasis 暴露史

ans: history of exposure

oh my goodness! aspergillosis is a fungal infection

but asbestosis: is a chemical induced lung parenchyma fibrosis!!!!石棉

damn!!!! stupid me!

Diagnosis

A complete blood count usually reveals eosinophilia more than 10% and there is a raised serum IgE more than 1000 ng/ml.

Chest radiography shows various transient abnormalities:

• consolidation, infiltrates or collapse
• thickened bronchial wall markings
• peripheral shadows
• signs of bronchiectasis, typically in a central location

Aspergillus specific tests^[1]:

• precipitating antibodies to aspergillus species in >90% of cases
• aspergillus-specific IgE RAST test
• skin-prick test is almost always positive to Aspergillus fumigatus

Fungal hyphae may be seen in the sputum.

[edit]Treatment

The aim of treatment is to suppress the immune reaction to the fungus and to control bronchospasm.

The immune reaction is suppressed using oral corticosteroids:

• a high dose of prednisolone or prednisone (30 to 45 mg per day) in acute attacks
• a lower maintenance dose (5–10 mg per day)

Mucus plugs may be removed by bronchoscopic aspiration. It is almost impossible to eradicate the fungus but frequently itraconazole (an anti-fungal) is used in combination with steroid therapy, which often results in a reduction of the steroid dose required. Regular monitoring of the condition includes chest x-rays,pulmonary function tests, and serum IgE. The antibody levels usually fall as the disease is controlled, but they may rise again as an early sign of flare-ups. There are also case reports of the use of omalizumab in the treatment of ABPA.^[2]