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Experience of allergic bronchopulmonal aspergillosis therapy in children with cystic fibrosis

[Cystic fibrosis]
Roman Mikhailovich Budzinsky; Elena Ivanovna Kondratieva; Nuriniso Dzhumaevna Odinaeva; Victoria Davidovna Sherman; Elena Kestutisovna Zhekaite;

Violation of mucociliary clearance and immune response, as well as prolonged antibacterial and glucocorticoid therapy, contribute to the development of allergic bronchopulmonary aspergillosis (ABPA) and pulmonary mycosis in CF patients. ABPA treatment regimens are discussed, and there is no information on relapse therapy. The aim of this work was to summarize the existing experience in the treatment of ABPA in children with cystic fibrosis in the children’s center for cystic fibrosis. А retrospective analysis of case histories of children observed in the center of CF for the period from 2016 to 2019 was carried out. The clinical manifestations of ABPA among the analyzed patients were in the form of increased cough, increased sputum discharge, manifestations of bronchial obstructive syndrome. Culturing of gram-negative non-enzymatic microflora was characteristic of all children diagnosed with ABPA, however, courses of systemic antibiotic therapy did not lead to significant dynamics in the condition of patients. An increase in total IgE was observed in 100% of patients with cystic fibrosis in ABPA and should be used as a screening among patients with CF. The use of combined antimycotic and glucocorticosteroid therapy leads to a cure for ABPA, but does not exclude a relapse. The course can range from 1 to 6 months. A burdened atopic history is a predisposing factor for the formation of a relapsing form of ABPA.

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Keywords: cystic fibrosis, CF, ABPA, voriconazole, itraconazole, aspergillosis, relapse


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