First Aspergillus fumigatus IgG seroconversion is associated with more
severe disease in CF children
Abstract
Background: Cystic fibrosis (CF) is the most common autosomal recessive
disease in Caucasian population. Allergic bronchopulmonary aspergillosis
(ABPA) is one of the severe complications of CF, on which diagnosis is
based on symptoms and blood IgE levels. Many techniques of specific IgG
levels measures are used, which signification is still unclear. We
evaluated evolution of patients who presented a first aspergillosis IgG
seroconversion. Methods: Monocentric pediatric case-control study led in
Rouen, France. Every patient with a first aspergillosis IgG
seroconversion was paired with a seronegative patient. Clinical data,
functional respiratory investigations, CT-scan and biologic data were
collected a year before (Y -1), a year after (Y
+1) and at the moment of the first aspergillosis
seroconversion. Results: 36 cases, paired with 36 controls. Median age
was 8. Forced expiratory volume in 1 second was significantly lower at Y
+1 (p=0,025) and Vital Capacity was significantly lower
at Y 0 (p= 0.027) in the case-population. More
respiratory exacerbations were observed in the case-population
(p=0,047). Higher specific IgE against A. fumigatus levels were observed
at Y 0 (p=0,014), Y -1 (p=0,001) and Y
+1 (p=0,04) in the case-population. Total IgG were
significantly higher at Y 0 in the case-population. On
the CT-scan, bronchiectasis and pulmonary infiltrates were more
important in the case-population (p=0,01 and p=0,003 respectively).
Conclusion: Aspergillosis seroconversion is associated with changes of
clinical, respiratory functional, biologic and radiologic parameters in
CF population. Aspergillosis seroconversion is a milestone in the
evolution of CF. A systematic research is needed, to evaluate actions to
be taken.