Allergic Bronchopulmonary Aspergillosis in Brazil

Abstract

Background: Prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic adults is estimated in 2,5%, what matches to more than 4.8 million of patients around the world; from those, more than 1.4 million are only in Latin America. Most patients with the disease are immunocompetent and present themselves with a poorly controlled asthma, secretive cough and recurrent pneumonia.  It’s curiously sensible to glucocorticoids, so early diagnosis and treatment may prevent bronchiectasis; otherwise, if it isn’t recognized soon, may lead to ending stage pulmonary fibrosis. First described by Hinson in 1952, even after almost seven decades, it’s still hardly recognized and treated. Methods and Findings: A case report was performed through clinical follow up of a patient evaluated in a Brazilian hospital diagnosed with ABPA after four years of poorly controlled asthma after even being in ICU and mechanic ventilation support. The patient presented eosinophilia high serum IgE, central bronchiectasis and positive prick test for Aspergillus fumigatus. There was also performed a integrative research of all the studies published in Brazil since the first case report in 1989. There were researched the platforms PubMed, BVS (that covers MedLine and LILACS bases), Scielo, Cochrane, JAMA, NEJM and LANCET using the descriptors “allergic bronchopulmonary aspergillosis” and “Brazil”. There was found 17 articles about ABPA, 10 meeting the inclusion criteria. Of those, only 4 covered clinical and epidemiological features of ABPA in asthmatic patients. Conclusions: There are very few studies on ABPA in Brazil in the last 30 years. More research in the country is needed to make this diagnostic possibility part of severe asthma differential and lead the patients to earlier diagnosis.