Turner E S, Greenberger P A, Sider L
Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611.
Allergy Proc. 1989 Jan-Feb;10(1):63-9. doi: 10.2500/108854189778968506.
The problem of attempting to diagnose allergic bronchopulmonary aspergillosis (ABPA) in children at an early age, prior to the development of undesirable sequelae, such as bronchiectasis, is reviewed. Two cases of ABPA with onset under the age of ten are presented as illustrations of the complexities of securing an early diagnosis of ABPA. ABPA is not infrequent in children, with children under ten representing an estimated 9% to 10% of patients with the disorder. A high index of suspicion and persistence are important in establishing the diagnosis. ABPA may be identified in patients with detectable central bronchiectasis (ABPA-CB) or in patients seropositive (ABPA-S) who do not yet have bronchiectasis. Some complexities in making an early diagnosis of ABPA include: 1) insensitivity of CT scans in detecting central bronchiectasis, 2) lack of current chest radiographic infiltrates, 3) lack of peripheral blood eosinophilia and precipitins to A. fumigatus and 4) weakly reactive immediate skin test to Aspergillus.
本文回顾了在儿童出现诸如支气管扩张等不良后遗症之前早期诊断变应性支气管肺曲霉病（ABPA）的问题。现呈现两例发病年龄在10岁以下的ABPA病例，以说明早期诊断ABPA的复杂性。ABPA在儿童中并不罕见，10岁以下儿童估计占该疾病患者的9%至10%。高度的怀疑指数和坚持不懈在确立诊断中很重要。ABPA可在可检测到中心性支气管扩张的患者（ABPA-CB）或尚未出现支气管扩张的血清阳性患者（ABPA-S）中被识别。早期诊断ABPA的一些复杂性包括：1）CT扫描检测中心性支气管扩张的不敏感性，2）当前胸部X线浸润影缺失，3）外周血嗜酸性粒细胞增多以及对烟曲霉沉淀素缺乏，4）对曲霉的即刻皮肤试验反应微弱。
