Complexities of establishing an early diagnosis of allergic bronchopulmonary aspergillosis in children.

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.