Tuesday, 17 June 2014

Substantial Underdiagnosis of Aspergillosis in Cystic Fibrosis Patients in 30 Countries Across the World

ABPA in Cystic Fibrosis adults
Aspergillus spp. can lead to allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitisation and Aspergillus bronchitis in Cystic Fibrosis patients, however it was not known how often this happens. This question was partially answered recently (Baxter et.al. 2013) using a large sample of the UK CF population and found the following proportions:

  • ABPA (17.7%)
  • Aspergillus sensitisation (14.6%) 
  • Aspergillus bronchitis (30%)


This new paper extends Baxter et.al. and based on its figures estimates the burden of aspergillosis and ABPA cases in adult CF patients in 30 countries that report CF.

Quoting:
Of the 76,201 estimated CF patients worldwide (not including India), 37,714 were >18 years. The proportion of adults to children varied from 63% in Norway to 20% in Brazil. ABPA caseload in adults is anticipated to be 6,675 cases of which only 2,221 cases (33%) are currently recorded, indicating substantial underdiagnosis. The ABPA diagnosis rate compared with estimated rates varies by country from 101% (France) to 14.5% (Greece), although genetic variation could account for genuine differences compared with the UK. Aspergillus bronchitis is not currently recognised or recorded in CF registries but there are an anticipated 10,988 adult cases.
Aspergillus sensitisation, associated with increased bronchiectasis and reduced FEV1, affects an anticipated 5,506 patients without ABPA or Aspergillus bronchitis. Together ABPA and Aspergillus bronchitis are estimated to affect 17,989 adults, 47.7% of the adult CF population.
ABPA also occurs in children and teenagers and 984 cases were documented in registries. Diagnosed ABPA rates by age were available for the ECFS registry, USA, UK, Ireland, Belgium and Netherlands. The rate was <1% under 4 years, and increased throughout childhood and adolescence, with marked variation between countries. Newly published diagnostic criteria and methods should facilitate better recognition of aspergillosis in CF, allowing better CF disease control.
Newly published diagnostic criteria and methods should facilitate better recognition of aspergillosis in CF, allowing better CF disease control.

Full article

No comments:

Amazon Contextual Product Ads

Contact us at admin@aspergillus.org.uk