Aspergillus IgG and IgE in hospitalized patients with bronchiectasis from a tertiary care hospital of eastern Assam

Aspergillus IgG and IgE in hospitalized patients with bronchiectasis from a tertiary care hospital of eastern Assam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Aspergillus IgG and IgE in hospitalized patients with bronchiectasis from a tertiary care hospital of eastern Assam Shivakumari Wahengbam, Reema Nath, pronami Borah, juma Das This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9311724/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Bronchiectasis is associated with a spectrum of Aspergillus-related lung diseases, including Aspergillus sensitization (AS), allergic bronchopulmonary aspergillosis (ABPA), and chronic pulmonary aspergillosis (CPA). Data on the immunological profile of these conditions from Northeast India are limited. Objectives: To evaluate Aspergillus fumigatus-specific IgE, IgG, and total IgE levels in hospitalized patients with bronchiectasis and to characterize Aspergillus-related disease phenotypes based on serological and clinico-radiological features. Methods: In this prospective cross-sectional study, 100 consecutive patients with HRCT-confirmed bronchiectasis were evaluated. Serum Aspergillus fumigatus-specific IgE, IgG, and total IgE were measured using the ImmunoCAP system. AS, ABPA, and CPA were defined using revised ISHAM (2024) and GAFFI/CDC criteria. Results: Aspergillus sensitization was observed in 34% of patients, while elevated Aspergillus-specific IgG was seen in 37%. Combined serological positivity (IgG > 27 mg/L, IgE > 0.35 kUA/L, and total IgE ≥ 500 IU/mL) was present in 14% of patients. Among IgG-positive patients, 37.8% fulfilled combined criteria. Structural lung disease (cavity and/or fungal ball) was present in 64.9% of IgG-positive patients and was significantly associated with overlap phenotype (p ≈ 0.03). Among asthma patients, 47.6% fulfilled ABPA immunological criteria. A subgroup of six patients without structural lung disease demonstrated full immunological positivity, including non-asthmatic individuals. Conclusion: Aspergillus-related lung disease in bronchiectasis represents a spectrum ranging from infection to hypersensitivity. Structural lung disease and asthma independently contribute to immunological activation, supporting a dual-pathway model. Recognition of this heterogeneity is important for accurate diagnosis and management, particularly in tuberculosis-endemic regions. Bronchiectasis Aspergillus sensitization ABPA CPA Tuberculosis IgE IgG Figures Figure 1 Figure 2 Introduction Globally, the prevalence of bronchiectasis appears to be increasing. 1 Bronchiectasis is linked to various Aspergillus -related conditions like chronic pulmonary aspergillosis (CPA), a condition most commonly found in post pulmonary TB population of endemic countries, and allergic bronchopulmonary aspergillosis (ABPA), which can develop as a complication of asthma or cystic fibrosis. 2 CPA is a long-term sequela of pulmonary tuberculosis with reported incidence ranging from 19% to 65%. 3 Aspergillus -related conditions in bronchiectasis may range from asymptomatic Aspergillu s colonization to CPA and Aspergillus sensitization (AS) to ABPA in individuals with immune hypersensitivity. 4 Aspergillus fumigatus- specific IgE and IgG remains an underutilized biomarker in routine clinical practice. Hence, detection of A. fumigatus -specific antibody is essential for diagnosing fungal hypersensitivity, CPA and ABPA in bronchiectasis patients, which may influence treatment strategies to prevent recurrent exacerbations and long-term complications. 5 , 6 Though several studies are available worldwide on AS and ABPA due to bronchial asthma and cystic fibrosis as predisposing factors, studies on all radiologically diagnosed bronchiectasis cases as an entry criterion are sparse. Most of the published reports are from advanced centres of North India and data from other peripheral parts of India are rare. This hospital-based prospective cross-sectional study was done in consecutive radiologically diagnosed bronchiectasis patients admitted to a tertiary care hospital of Eastern Assam with the objective of estimating the prevalence of Aspergillus specific IgE and IgG antibody and clinical and radiological correlation to help in diagnosing the cases. METHODS Study setting: This was a hospital-based prospective cross-sectional study done between December 2023 to November 2024 in consecutive high-resolution computed tomography (HRCT)-diagnosed bronchiectasis patients admitted in the Medicine department of a peripheral tertiary care hospital of Eastern Assam. A total of 100 consecutive radiologically diagnosed bronchiectasis patients who were admitted with chronic respiratory symptoms and or exacerbations were included. We included all the cases of HRCT-diagnosed bronchiectasis as we wanted to detect the occurrence of AS, CPA and ABPA in our admitted patients with bronchiectasis. Patients below 13 years of age were excluded. The Institutional Ethics Committee (Human) approved the study, and informed consents were obtained from every patient in their language. Study procedures: All the admitted patients with chronic respiratory symptoms with HRCT diagnosed bronchiectasis with or without acute exacerbations were tested for i) Aspergillus fumigatus specific IgE, ii) Aspergillus fumigatus specific IgG, and iii) Total IgE. Relevant clinical history was taken from all the cases meeting the inclusion criteria, and with the help of a preformed proforma, the sociodemographic data, significant tuberculosis history, bronchial asthma, and history of other premorbid conditions were collected. Three milliliters of blood samples were collected from the patients. Aspergillus fumigatus -specific IgE, serum total IgE, and Aspergillus fumigatus -specific IgG were determined by ImmunoCap PHADIA 200 (Thermo Fisher, Uppsala, Sweden) according to the manufacturer's instructions. Case definition/ Diagnostic criteria : Aspergillus sensitization (AS): Serum Aspergillus fumigatus Specific IgE > 0.35 kUA/l is considered significant. 7 , 8 Revised criteria for diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) by International Society for Human and Animal Mycology (ISHAM)-ABPA working group (AWG), 2024: 8 Predisposing conditions 1.Asthma, cystic fibrosis, chronic obstructive lung disease, bronchiectasis or compatible clinico-radiological presentation. Essential components 1. A. fumigatus-specific IgE ≥ 0.35 kUA/L 2. Serum total IgE ≥ 500 IU/mL Other components (any two) 1. IgG against A. fumigatus 2. Blood eosinophil count ≥ 500 cells/µL (could be historical) 3. Thin-section chest computed tomography consistent with ABPA (bronchiectasis, mucus plugging and high-attenuation mucus) or fleeting opacities on chest radiograph consistent with ABPA. In our study, the diagnosis of ABPA was made upon fulfilment of the predisposing condition and both the ‘essential components’, i.e, serum Aspergillus fumigatus -specific IgE ≥ 0.35 kUA/L, serum total IgE ≥ 500 IU/mL, and two of the three ‘other criteria’, i.e, IgG antibodies against Aspergillus fumigatus ≥ 27 mgA/L, bronchiectasis on thin-section chest computed tomography consistent with ABPA. 3.Chronic Pulmonary Aspergillosis(CPA): The definition of chronic pulmonary aspergillosis (CPA) is as per the definition by GAFFI (Global action fund for fungal infection) as adopted by CDC 9 a. Clinically, major required symptoms are persistent cough with or without haemoptysis and weight loss for a minimum period of 3 months. Others commonly present are fatigue/tiredness, productive sputum, dyspnoea, and chest pain (but not a required criteria). b. Microbiologically, seropositivity of Aspergillus -specific IgG antibody and/or microscopy of sputum samples showing (dichotomous branching and septate hyphae) hyphae of Aspergillus and/or growth of Aspergillus species in more than 2 sputum samples or other respiratory samples such as bronchoalveolar lavage (BAL), lung biopsy, and fluid aspirated from cavity (if present) or from pleural effusion is required. c. Radiologically, chest imaging that shows either cavitation or a fungal ball inside the cavity or thickening of the pleura or fibrosis or infiltrates around the cavities. d. A negative sputum smear, GeneXpert, and/or mycobacterial culture in order to rule out mycobacterial infection is necessary. 4.TB-related bronchiectasis was diagnosed in patients with a history of pulmonary tuberculosis and radiological evidence of post-TB changes. Statistical analysis Data were analyzed using descriptive and inferential statistics. Continuous variables were expressed as mean ± standard deviation (SD) or median (interquartile range, IQR) as appropriate, while categorical variables were presented as frequencies and percentages. Comparisons between groups were performed using the Mann–Whitney U test for continuous variables. Associations between categorical variables were assessed using Fisher’s exact test. A two-tailed p-value of < 0.05 was considered statistically significant. Results Patient characteristics A total of 100 patients (mean age 46.8 ± 14.5 years; 50% female) were included. The most common presenting symptoms were cough (82%), haemoptysis (35%), fever (44%), and wheezing (35%). The median number of lobes involved was 2 (IQR 1–4), with the right upper lobe being most frequently affected (50%). Cavitary lesions were observed in 17% of patients, while fungal balls were present in 15%. Tuberculosis was the most common etiology of bronchiectasis (64%).Table 1 is showing patient characteristics. Table 1 Showing patient characteristics Variable Value Age (years), mean ± SD 46.8 ± 14.5 Female sex, n (%) 50 (50) Symptoms Cough, n (%) 82 (82) Hemoptysis, n (%) 35 (35) Fever, n (%) 44 (44) Dyspnoea, n (%) 41 (41) Wheezing, n (%) 35 (35) Weight loss, n (%) 13 (13) Radiology Cavity, n (%) 17 (17) Fungal ball, n (%) 15 (15) Lobes involved, median (IQR) 2 (1–4) Right upper lobe involvement, n (%) 50 (50) Etiology Tuberculosis, n (%) 64 (64) Immunological profile The median (IQR) levels of Aspergillus fumigatus-specific IgE, IgG, and total IgE were 0.14 (0–18.3) kUA/L, 22.8 (0.75–240) mgA/L, and 966 (24.7–5000) IU/mL, respectively. Aspergillus sensitization (IgE >0.35 kUA/L) was observed in 34% of patients, while elevated Aspergillus-specific IgG (>27 mgA/L) was detected in 37%. Co-positivity of IgE and IgG was observed in 24% of patients. Total IgE ≥500 IU/mL was present in 64% of the study population. Based on clinico-radiological and microbiological criteria, 23% of patients were categorized as chronic pulmonary aspergillosis (CPA). Comparison between post-tuberculosis and non-tuberculosis bronchiectasis Post-tuberculosis bronchiectasis accounted for 64% of cases. Hemoptysis (p = 0.04) and wheezing (p = 0.003) were significantly more frequent in the tuberculosis group. The right upper lobe was more commonly involved in post-tuberculosis cases (94.1%). Fungal ball was significantly associated with tuberculosis (p = 0.0369). Aspergillus sensitization (37.5%), elevated IgG (46.8%), and combined IgE–IgG positivity (29.6%) were more frequent among post-tuberculosis patients. Aspergillus sensitization Among sensitized patients (34%), males predominated (68%, p = 0.01). Agricultural occupation was significantly associated with sensitization (61.7%, p = 0.05). Sensitization was more frequent in post-tuberculosis patients (44%, p = 0.03). Among asthma patients (n = 21), 81% demonstrated sensitization, and 47.6% fulfilled immunological criteria for ABPA. Wheezing was the most significant symptom associated with sensitization (p < 0.05). Radiologically, cystic bronchiectasis was most common (97%), with right upper lobe predominance (55.8%). Fungal ball (32.4%, p < 0.05) and cavitary lesions (29.4%, p = 0.02) were significantly associated findings. Table 2 : Asthma patients showing combined serological positivity. Table2: Asthma patients with fulfilling serological criteria of ABPA (n=10) Case No Cavity Fungal ball IgE IgG Total IgE 3 Yes No 0.99 44.7 2120 30 No No 0.39 54.0 2894 47 Yes Yes 2.07 74.4 1398 49 Yes No 0.46 158.0 2292 63 Yes Yes 0.90 61.6 1962 68 No Yes 18.30 197.0 2148 76 No Yes 0.38 107.0 1275 82 Yes Yes 0.52 91.2 3030 96 No No 0.73 49.2 1881 97 No No 0.78 125.0 966 Table 3: Non asthmatic patients with or without cavity, fungal ball showing overlap(n=10/16) Case Cavity Fungal ball IgE IgG Total IgE Overlap 4 Yes No 0.62 58 732 Yes 9 Yes No 0.63 48 276 No 18 Yes No 0.48 39 880 Yes 27 Yes Yes 0.55 72 910 Yes 41 Yes Yes 0.67 44 690 Yes 48 Yes Yes 0.34 35 3905 No 52 Yes No 0.52 37 820 Yes 64 Yes Yes 0.61 85 970 Yes 72 No No 0.33 55 760 No 74 Yes No 0.47 48 920 Yes 75 No Yes 0.36 62 1010 Yes 78 Yes Yes 0.49 33 740 Yes 88 Yes No 0.57 41 860 Yes 95 No No 0.31 35 420 No 98 No No 0.29 60 350 No 99 No No 0.22 42 300 No CPA and CPA–ABPA overlap phenotype A total of 37% (37/100) of patients had elevated Aspergillus-specific IgG (>27 mgA/L). Among these, 64.9% demonstrated cavitary lesions and/or fungal ball. Combined serological positivity of all three parameters was observed in 37.8% (14/37) of IgG-positive patients. Structural lung disease (cavity and/or fungal ball) was significantly associated with overlap phenotype (p ≈ 0.03). Among asthma patients, 10 cases fulfilled combined serological criteria, of which 50% had cavitary lesions and/or fungal ball. Among non-asthmatic patients with elevated IgG (n = 16), 62.5% (10/16) demonstrated combined serological positivity. Structural lung disease was present in 68.8% (11/16) of these patients and was significantly associated with overlap phenotype. Overall, 14% (14/100) of patients were classified as CPA–ABPA overlap phenotype. Non-structural ABPA immune phenotype : Six patients without cavitary lesions or fungal ball fulfilled combined immunological criteria. Among these, 66.7% (4/6) had asthma, while 33.3% (2/6) were non-asthmatic. Prior tuberculosis was present in 66.7% (4/6) of patients. These cases were categorized as ABPA phenotype without structural lung disease. Table 4: Non structural ABPA phenotype without cavity and or fungal ball Case Asthma TB IgE IgG Total IgE 30 Yes No 0.39 54.0 2894 50 Yes Yes 0.58 32.9 887 75 No Yes 0.43 43.3 2886 91 Yes No 1.08 190.0 2414 96 Yes Yes 0.73 49.2 1881 97 No Yes 0.78 125.0 966 Immunological comparisons Patients with CPA–ABPA overlap demonstrated higher and more variable IgG levels compared to CPA alone, along with a broader distribution of IgE and total IgE levels. Patients with ABPA phenotype demonstrated markedly elevated IgE and total IgE levels consistent with hypersensitivity-driven disease.(Figure 1 and 2) DISCUSSION In this study, we evaluated the immunological spectrum of Aspergillus-related lung disease in a cohort of 100 hospitalized patients with bronchiectasis with radiological correlation, with a particular focus on the interaction between structural lung disease and immune responses. Our findings demonstrate marked heterogeneity within the Aspergillus IgG-positive population and support a continuum model linking chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and overlap phenotypes. A key observation was that 37.8% of patients with elevated Aspergillus-specific IgG fulfilled combined immunological criteria, indicating that IgG positivity alone is insufficient to define an overlap phenotype. This is consistent with recent evidence suggesting that Aspergillus-specific IgG primarily reflects chronic exposure and hypersensitivity must be interpreted alongside with IgE and total IgE levels 10 , 11 . Thus, reliance on a single immunological marker may lead to misclassification, emphasizing the importance of combined serological assessment. Recent ISHAM guidelines (2024–2025) have proposed a stepwise diagnostic approach beginning with Aspergillus-specific IgE, followed by total IgE, and subsequently IgG and imaging to define disease phenotype 12 , 13 . Our findings closely align with this framework, demonstrating that combined elevation of IgE and total IgE identifies a distinct immunologically active subset within the broader IgG-positive cohort. A major finding of our study is the strong association between structural lung disease represented by cavity and or fungal ball and immunological activation. Patients with cavitary lesions and/or fungal ball demonstrated a high prevalence of combined immunological positivity including hypersensitivity, supporting the hypothesis that structural damage and fungal burden act as key drivers of immune activation. Persistent colonization of damaged lung parenchyma likely leads to continuous antigen exposure, resulting in both IgG- and IgE-mediated responses 11 , 14 . This is particularly relevant in post-tuberculosis populations, where structural lung abnormalities are common and predispose to chronic Aspergillus infection 15 , 16 . Importantly, we also identified a subgroup of patients ( n = 6 ) with no cavitary lesions but full immunological positivity. While the majority of these patients had asthma (n = 4, 66.7%), a notable proportion (33.3%) did not, indicating that asthma is not an absolute requirement for immunological activation or ABPA like phenotype. Emerging evidence has reported ABPA-like disease in non-asthmatic individuals, suggesting broader host–fungal interactions beyond classical paradigms 17 . Four of the patients also had tuberculosis ( 66.7%) in this non-structural overlap subgroup. Post-tuberculosis lung disease is increasingly recognized as a major contributor to chronic respiratory morbidity and a risk factor for fungal colonization and sensitization 15 , 16 . Taken together, our findings support a multifactorial “two-hit” model of Aspergillus-related lung disease, wherein either host predisposition (such as asthma) or structural lung damage (such as post-tuberculosis changes) c an independently or synergistically drive immunological activation. The presence of overlap phenotype in both structural and non-structural groups underscores the concept that CPA and ABPA represent different manifestations along a shared disease spectrum 11 , 18 . Clinically, these findings have important implications. First, they highlight the need for integrated evaluation combining radiological and immunological parameters. Second, they suggest that Aspergillus -related hypersensitivity should be considered even in non-asthmatic patients, particularly in tuberculosis-endemic regions which may improve diagnostic accuracy and guide therapeutic strategies. However, our study has certain limitations. It was a time bound study of 1-year duration. The sample size of specific subgroups, particularly non-structural overlap patients, was small, limiting statistical power. We have not evaluated the cause of bronchiectasis in cases besides TB. Despite these limitations, our study provides important real-world insights into the evolving understanding of Aspergillus -related lung disease. Conclusion In conclusion, our study demonstrates that CPA–ABPA overlap represents a dominant phenotype in structurally diseased lungs, with asthma significantly amplifying the immunological response. Recognition of this heterogeneity is essential for accurate classification and personalized management of Aspergillus-related lung disease. Abbreviations CPA: chronic Pulmonary Aspergillosis, ABPA: Allergic Broncho pulmonary Aspergillosis, AS: Aspergillus sensitization Declarations ● Ethics approval and consent to participate: Ethical approval was taken from the institutional Ethics Committee (human) of Assam Medical College No. AMC/EC/2025/2166. Written informed consent was taken from all the participants before inclusion in the study. ● Consent for publication: Consent for publication is taken from the participants. ● Availability of data and materials: Data is available in the paper and also with the first author and the corresponding author . It is available on request. ● Competing Interests: The authors declare that they have no competing interests. ● Funding: This work received no external funding. ● Authors' contributions: SW : Concept, Data collection ,analysis of data ,writing the manuscript, RN: Conceptualized, Analysis of data, Writing the manuscript. PB and JD: Data collection, Analysis of data, Reviewed the manuscript. Acknowledgements: Not applicable References Dhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India registry. Lancet Glob Health . 2019;7(9):e1269–79. De Soyza A, Aliberti S. Bronchiectasis and Aspergillus: how are they linked? Med Mycol . 2017;55(1):69–81. Hashem MK, Nasim YSM, Mohamed-Hussein AAR, Shaddad AM. 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Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. Eur Respir J . 2024;63(4):2400061. Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines. Eur Respir J . 2016;47(1):45–68. Lozier B, Nguyen MH, Clancy CJ, et al. Determination of positivity cutoff for Aspergillus -specific IgG. J Appl Lab Med . 2025;10(3):619–30. Pham TQ, et al. Pulmonary aspergillosis: epidemiology and unresolved issues. Med Mycol . 2025;63(2):myad012. Agarwal R, Sehgal IS, Muthu V, Dhooria S, Prasad KT, Aggarwal AN, et al. The 2024 ISHAM-ABPA working group guidelines. Lung India . 2025;42(3):1–12. Agarwal R, Sehgal IS, Muthu V, Denning DW, Chakrabarti A, Soundappan K, et al. Revised diagnostic criteria for allergic bronchopulmonary aspergillosis. Eur Respir J . 2024;63(2):2300934. Xu J, et al. Updated clinical practice guidelines for allergic bronchopulmonary aspergillosis/mycosis. Eur Respir Rev . 2024;33(172):230221. Zhang M, et al. Allergic bronchopulmonary aspergillosis in non-asthmatic patients: an emerging phenotype. Respir Med Case Rep . 2026;45:101889. Stjepanovic M, et al. Pulmonary aspergillosis in asthma: clinical implications. J Infect Dev Ctries . 2025;19(2):123–30. Soundappan K, Muthu V, Dhooria S, Sehgal IS, Prasad KT, Rudramurthy SM, et al. Aspergillus sensitization and allergic bronchopulmonary aspergillosis detection. Mycoses . 2024;67(8):e13784. MSD Manual Professional Version. Allergic bronchopulmonary aspergillosis (ABPA). Available from: https://www.msdmanuals.com Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9311724","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634919493,"identity":"58d4b15d-8da2-4826-bbbd-45791d0f0cca","order_by":0,"name":"Shivakumari Wahengbam","email":"","orcid":"","institution":"Assam Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shivakumari","middleName":"","lastName":"Wahengbam","suffix":""},{"id":634919505,"identity":"5523e883-64e6-4100-94ef-abbe62c1c385","order_by":1,"name":"Reema Nath","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYDADAygtByIOPCBChwRMizFYSwIpWhIbQCQ+LebtzUc3/NxhV2fOwPz444+abenzww4/BNpiJ6fbgF2LzJljaTd7zyRLWDawmUnzHLudu/F2mgFQS7Kx2QEcDpLIMbvB28YsYXCAwYyZgQ2oZXYCSMuBxG24tMi//3bzb1s9UAv7548//t1ON5yd/gG/Fgkettu8bYeBWngMJHjbbifIS+cQsIUnzey2bNtxyQ2HecqkeftuG26Qzik4kGCAxy/sh5/dfNtWzW9wvH3zxx/fbsvLz07f/OFDhZ0cLi0IwAylDcAqDXArxATyDaSoHgWjYBSMgpEAAORYYxhZrJwQAAAAAElFTkSuQmCC","orcid":"","institution":"Assam Medical College and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Reema","middleName":"","lastName":"Nath","suffix":""},{"id":634919516,"identity":"25328348-5fdc-4ce3-98ee-59e4a2236a1c","order_by":2,"name":"pronami Borah","email":"","orcid":"","institution":"Assam Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"pronami","middleName":"","lastName":"Borah","suffix":""},{"id":634919519,"identity":"af4cc801-1df9-4431-880d-410abb1bfdd8","order_by":3,"name":"juma Das","email":"","orcid":"","institution":"Assam Medical College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"juma","middleName":"","lastName":"Das","suffix":""}],"badges":[],"createdAt":"2026-04-03 10:09:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9311724/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9311724/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108945332,"identity":"d6fc1386-acf9-480e-8b12-1e95c779312a","added_by":"auto","created_at":"2026-05-11 06:15:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":173838,"visible":true,"origin":"","legend":"\u003cp\u003eComposite multi-panel box plots comparing Aspergillus-specific IgE (A), IgG (B), and total IgE (C) across CPA, CPA–ABPA overlap, and ABPA phenotypes. The ABPA group demonstrates markedly elevated IgE and total IgE levels, while the overlap group shows intermediate and variable distributions across all parameters.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9311724/v1/d93bb235d37a17a47e9b278b.png"},{"id":108945333,"identity":"7386984e-a368-4571-9580-dd87493e9a0c","added_by":"auto","created_at":"2026-05-11 06:15:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":149277,"visible":true,"origin":"","legend":"\u003cp\u003eComposite multi-panel box plots comparing Aspergillus-specific IgE (A), IgG (B), and total IgE (C) between asthma and non-asthma patients within the CPA–ABPA overlap group. Asthma patients demonstrate higher IgE and total IgE levels, while IgG remains elevated in both groups.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9311724/v1/ac42b72d1b1c70f62d61274e.png"},{"id":108977540,"identity":"c0be40ff-9e7f-4a1d-a54c-bc3d33df9248","added_by":"auto","created_at":"2026-05-11 11:32:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":557189,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9311724/v1/2c5f8a0e-70a2-49a1-b882-3158d194f68e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Aspergillus IgG and IgE in hospitalized patients with bronchiectasis from a tertiary care hospital of eastern Assam","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, the prevalence of bronchiectasis appears to be increasing.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Bronchiectasis is linked to various \u003cem\u003eAspergillus\u003c/em\u003e-related conditions like chronic pulmonary aspergillosis (CPA), a condition most commonly found in post pulmonary TB population of endemic countries, and allergic bronchopulmonary aspergillosis (ABPA), which can develop as a complication of asthma or cystic fibrosis.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e CPA is a long-term sequela of pulmonary tuberculosis with reported incidence ranging from 19% to 65%.\u003csup\u003e3\u003c/sup\u003e \u003cem\u003eAspergillus\u003c/em\u003e-related conditions in bronchiectasis may range from asymptomatic \u003cem\u003eAspergillu\u003c/em\u003es colonization to CPA and \u003cem\u003eAspergillus\u003c/em\u003e sensitization (AS) to ABPA in individuals with immune hypersensitivity.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e \u003cem\u003eAspergillus fumigatus-\u003c/em\u003especific IgE and IgG remains an underutilized biomarker in routine clinical practice. Hence, detection of \u003cem\u003eA. fumigatus\u003c/em\u003e-specific antibody is essential for diagnosing fungal hypersensitivity, CPA and ABPA in bronchiectasis patients, which may influence treatment strategies to prevent recurrent exacerbations and long-term complications.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Though several studies are available worldwide on AS and ABPA due to bronchial asthma and cystic fibrosis as predisposing factors, studies on all radiologically diagnosed bronchiectasis cases as an entry criterion are sparse. Most of the published reports are from advanced centres of North India and data from other peripheral parts of India are rare.\u003c/p\u003e \u003cp\u003eThis hospital-based prospective cross-sectional study was done in consecutive radiologically diagnosed bronchiectasis patients admitted to a tertiary care hospital of Eastern Assam with the objective of estimating the prevalence of \u003cem\u003eAspergillus\u003c/em\u003e specific IgE and IgG antibody and clinical and radiological correlation to help in diagnosing the cases.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting:\u003c/h2\u003e \u003cp\u003eThis was a hospital-based prospective cross-sectional study done between December 2023 to November 2024 in consecutive high-resolution computed tomography (HRCT)-diagnosed bronchiectasis patients admitted in the Medicine department of a peripheral tertiary care hospital of Eastern Assam. A total of 100 consecutive radiologically diagnosed bronchiectasis patients who were admitted with chronic respiratory symptoms and or exacerbations were included. We included all the cases of HRCT-diagnosed bronchiectasis as we wanted to detect the occurrence of AS, CPA and ABPA in our admitted patients with bronchiectasis. Patients below 13 years of age were excluded.\u003c/p\u003e \u003cp\u003e The Institutional Ethics Committee (Human) approved the study, and informed consents were obtained from every patient in their language.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy procedures:\u003c/h3\u003e\n\u003cp\u003eAll the admitted patients with chronic respiratory symptoms with HRCT diagnosed bronchiectasis with or without acute exacerbations were tested for i) \u003cem\u003eAspergillus fumigatus\u003c/em\u003e specific IgE, ii) \u003cem\u003eAspergillus fumigatus\u003c/em\u003e specific IgG, and iii) Total IgE.\u003c/p\u003e \u003cp\u003eRelevant clinical history was taken from all the cases meeting the inclusion criteria, and with the help of a preformed proforma, the sociodemographic data, significant tuberculosis history, bronchial asthma, and history of other premorbid conditions were collected.\u003c/p\u003e \u003cp\u003eThree milliliters of blood samples were collected from the patients. \u003cem\u003eAspergillus fumigatus\u003c/em\u003e-specific IgE, serum total IgE, and \u003cem\u003eAspergillus fumigatus\u003c/em\u003e-specific IgG were determined by ImmunoCap PHADIA 200 (Thermo Fisher, Uppsala, Sweden) according to the manufacturer's instructions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCase definition/ Diagnostic criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eAspergillus\u003c/em\u003e sensitization (AS): Serum \u003cem\u003eAspergillus fumigatus\u003c/em\u003e Specific IgE\u0026thinsp;\u0026gt;\u0026thinsp;0.35 kUA/l is considered significant.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRevised criteria for diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) by International Society for Human and Animal Mycology (ISHAM)-ABPA working group (AWG), 2024:\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredisposing conditions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.Asthma, cystic fibrosis, chronic obstructive lung disease, bronchiectasis or compatible clinico-radiological presentation.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEssential components\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. \u003cem\u003eA. fumigatus-specific\u003c/em\u003e IgE\u0026thinsp;\u0026ge;\u0026thinsp;0.35 kUA/L\u003c/p\u003e \u003cp\u003e2. Serum total IgE\u0026thinsp;\u0026ge;\u0026thinsp;500 IU/mL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther components (any two)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1. IgG against \u003cem\u003eA. fumigatus\u003c/em\u003e\u003c/p\u003e \u003cp\u003e2. Blood eosinophil count\u0026thinsp;\u0026ge;\u0026thinsp;500 cells/\u0026micro;L (could be historical)\u003c/p\u003e \u003cp\u003e3. Thin-section chest computed tomography consistent with ABPA (bronchiectasis, mucus plugging and high-attenuation mucus) or fleeting opacities on chest radiograph consistent with ABPA.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn our study, the diagnosis of ABPA was made upon fulfilment of the predisposing condition and both the \u0026lsquo;essential components\u0026rsquo;, i.e, serum \u003cem\u003eAspergillus fumigatus\u003c/em\u003e-specific IgE\u0026thinsp;\u0026ge;\u0026thinsp;0.35 kUA/L, serum total IgE\u0026thinsp;\u0026ge;\u0026thinsp;500 IU/mL, and two of the three \u0026lsquo;other criteria\u0026rsquo;, i.e, IgG antibodies against \u003cem\u003eAspergillus fumigatus\u003c/em\u003e\u0026thinsp;\u0026ge;\u0026thinsp;27 mgA/L, bronchiectasis on thin-section chest computed tomography consistent with ABPA.\u003c/p\u003e \u003cp\u003e3.Chronic Pulmonary Aspergillosis(CPA): The definition of chronic pulmonary aspergillosis (CPA) is as per the definition by GAFFI (Global action fund for fungal infection) as adopted by CDC \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ea. Clinically, major required symptoms are persistent cough with or without haemoptysis and weight loss for a minimum period of 3 months. Others commonly present are fatigue/tiredness, productive sputum, dyspnoea, and chest pain (but not a required criteria).\u003c/p\u003e \u003cp\u003eb. Microbiologically, seropositivity of \u003cem\u003eAspergillus\u003c/em\u003e-specific IgG antibody and/or microscopy of sputum samples showing (dichotomous branching and septate hyphae) hyphae of \u003cem\u003eAspergillus\u003c/em\u003e and/or growth of \u003cem\u003eAspergillus\u003c/em\u003e species in more than 2 sputum samples or other respiratory samples such as bronchoalveolar lavage (BAL), lung biopsy, and fluid aspirated from cavity (if present) or from pleural effusion is required.\u003c/p\u003e \u003cp\u003ec. Radiologically, chest imaging that shows either cavitation or a fungal ball inside the cavity or thickening of the pleura or fibrosis or infiltrates around the cavities.\u003c/p\u003e \u003cp\u003ed. A negative sputum smear, GeneXpert, and/or mycobacterial culture in order to rule out mycobacterial infection is necessary.\u003c/p\u003e \u003cp\u003e4.TB-related bronchiectasis was diagnosed in patients with a history of pulmonary tuberculosis and radiological evidence of post-TB changes.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using descriptive and inferential statistics. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median (interquartile range, IQR) as appropriate, while categorical variables were presented as frequencies and percentages. Comparisons between groups were performed using the Mann\u0026ndash;Whitney U test for continuous variables. Associations between categorical variables were assessed using Fisher\u0026rsquo;s exact test. A two-tailed p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eA total of 100 patients (mean age 46.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5 years; 50% female) were included. The most common presenting symptoms were cough (82%), haemoptysis (35%), fever (44%), and wheezing (35%). The median number of lobes involved was 2 (IQR 1\u0026ndash;4), with the right upper lobe being most frequently affected (50%). Cavitary lesions were observed in 17% of patients, while fungal balls were present in 15%. Tuberculosis was the most common etiology of bronchiectasis (64%).Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e is showing patient characteristics.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShowing patient characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoptysis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnoea, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWheezing, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight loss, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRadiology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCavity, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungal ball, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLobes involved, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight upper lobe involvement, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEtiology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTuberculosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eImmunological profile\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median (IQR) levels of Aspergillus fumigatus-specific IgE, IgG, and total IgE were 0.14 (0–18.3) kUA/L, 22.8 (0.75–240) mgA/L, and 966 (24.7–5000) IU/mL, respectively. Aspergillus sensitization (IgE \u0026gt;0.35 kUA/L) was observed in 34% of patients, while elevated Aspergillus-specific IgG (\u0026gt;27 mgA/L) was detected in 37%. Co-positivity of IgE and IgG was observed in 24% of patients. Total IgE ≥500 IU/mL was present in 64% of the study population. Based on clinico-radiological and microbiological criteria, 23% of patients were categorized as chronic pulmonary aspergillosis (CPA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison between post-tuberculosis and non-tuberculosis bronchiectasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-tuberculosis bronchiectasis accounted for 64% of cases. Hemoptysis (p = 0.04) and wheezing (p = 0.003) were significantly more frequent in the tuberculosis group. The right upper lobe was more commonly involved in post-tuberculosis cases (94.1%). Fungal ball was significantly associated with tuberculosis (p = 0.0369). Aspergillus sensitization (37.5%), elevated IgG (46.8%), and combined IgE–IgG positivity (29.6%) were more frequent among post-tuberculosis patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAspergillus sensitization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong sensitized patients (34%), males predominated (68%, p = 0.01). Agricultural occupation was significantly associated with sensitization (61.7%, p = 0.05). Sensitization was more frequent in post-tuberculosis patients (44%, p = 0.03). Among asthma patients (n = 21), 81% demonstrated sensitization, and 47.6% fulfilled immunological criteria for ABPA. Wheezing was the most significant symptom associated with sensitization (p \u0026lt; 0.05). Radiologically, cystic bronchiectasis was most common (97%), with right upper lobe predominance (55.8%). Fungal ball (32.4%, p \u0026lt; 0.05) and cavitary lesions (29.4%, p = 0.02) were significantly associated findings. Table 2 : Asthma patients showing combined serological positivity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable2: Asthma patients with fulfilling serological criteria of ABPA (n=10)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCase No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCavity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFungal ball\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIgE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIgG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal IgE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2894\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1398\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1962\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e197.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e107.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1881\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e125.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e966\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Non asthmatic patients with or without cavity, fungal ball showing overlap(n=10/16)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCavity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFungal ball\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIgE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIgG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal IgE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOverlap\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e910\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCPA and CPA–ABPA overlap phenotype\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 37% (37/100) of patients had elevated Aspergillus-specific IgG (\u0026gt;27 mgA/L). Among these, 64.9% demonstrated cavitary lesions and/or fungal ball. \u003cstrong\u003eCombined serological positivity of all three parameters was observed in 37.8% (14/37) of IgG-positive patients.\u003c/strong\u003e Structural lung disease (cavity and/or fungal ball) was significantly associated with overlap phenotype (p ≈ 0.03).\u003c/p\u003e\n\u003cp\u003eAmong asthma patients, 10 cases fulfilled combined serological criteria, of which 50% had cavitary lesions and/or fungal ball. Among non-asthmatic patients with elevated IgG (n = 16), 62.5% (10/16) demonstrated combined serological positivity. Structural lung disease was present in 68.8% (11/16) of these patients and was significantly associated with overlap phenotype.\u003c/p\u003e\n\u003cp\u003eOverall, \u003cstrong\u003e14% (14/100) of patients were classified as CPA–ABPA overlap phenotype.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNon-structural ABPA immune phenotype :\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix patients without cavitary lesions or fungal ball fulfilled combined immunological criteria. Among these, 66.7% (4/6) had asthma, while 33.3% (2/6) were non-asthmatic. Prior tuberculosis was present in 66.7% (4/6) of patients. These cases were categorized as ABPA phenotype without structural lung disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Non structural ABPA phenotype without cavity and or fungal ball\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAsthma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIgE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIgG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal IgE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2894\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e190.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2414\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1881\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e125.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e966\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eImmunological comparisons\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with CPA–ABPA overlap demonstrated higher and more variable IgG levels compared to CPA alone, along with a broader distribution of IgE and total IgE levels. Patients with ABPA phenotype demonstrated markedly elevated IgE and total IgE levels consistent with hypersensitivity-driven disease.(Figure 1 and 2)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we evaluated the immunological spectrum of Aspergillus-related lung disease in a cohort of 100 hospitalized patients with bronchiectasis with radiological correlation, with a particular focus on the interaction between structural lung disease and immune responses. Our findings demonstrate marked heterogeneity within the Aspergillus IgG-positive population and support a continuum model linking chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and overlap phenotypes.\u003c/p\u003e \u003cp\u003eA key observation was that 37.8% of patients with elevated Aspergillus-specific IgG fulfilled combined immunological criteria, indicating that IgG positivity alone is insufficient to define an overlap phenotype. This is consistent with recent evidence suggesting that Aspergillus-specific IgG primarily reflects chronic exposure and hypersensitivity must be interpreted alongside with IgE and total IgE levels \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Thus, reliance on a single immunological marker may lead to misclassification, emphasizing the importance of combined serological assessment.\u003c/p\u003e \u003cp\u003eRecent ISHAM guidelines (2024\u0026ndash;2025) have proposed a stepwise diagnostic approach beginning with Aspergillus-specific IgE, followed by total IgE, and subsequently IgG and imaging to define disease phenotype \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Our findings closely align with this framework, demonstrating that combined elevation of IgE and total IgE identifies a distinct immunologically active subset within the broader IgG-positive cohort.\u003c/p\u003e \u003cp\u003eA major finding of our study is the strong association between structural lung disease represented by cavity and or fungal ball and immunological activation. Patients with cavitary lesions and/or fungal ball demonstrated a high prevalence of combined immunological positivity including hypersensitivity, supporting the hypothesis that structural damage and fungal burden act as key drivers of immune activation. Persistent colonization of damaged lung parenchyma likely leads to continuous antigen exposure, resulting in both IgG- and IgE-mediated responses \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. This is particularly relevant in post-tuberculosis populations, where structural lung abnormalities are common and predispose to chronic Aspergillus infection \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eImportantly, we also identified a subgroup of patients \u003cb\u003e(\u003c/b\u003en\u0026thinsp;=\u0026thinsp;6\u003cb\u003e)\u003c/b\u003e with no cavitary lesions but full immunological positivity. While the majority of these patients had asthma (n\u0026thinsp;=\u0026thinsp;4, 66.7%), a notable proportion (33.3%) did not, indicating that asthma is not an absolute requirement for immunological activation or ABPA like phenotype. Emerging evidence has reported ABPA-like disease in non-asthmatic individuals, suggesting broader host\u0026ndash;fungal interactions beyond classical paradigms \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Four of the patients also had tuberculosis ( 66.7%) in this non-structural overlap subgroup. Post-tuberculosis lung disease is increasingly recognized as a major contributor to chronic respiratory morbidity and a risk factor for fungal colonization and sensitization \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTaken together, our findings support a multifactorial \u0026ldquo;two-hit\u0026rdquo; model of Aspergillus-related lung disease, wherein either host predisposition (such as asthma) or structural lung damage (such as post-tuberculosis changes) \u003cb\u003ec\u003c/b\u003ean independently or synergistically drive immunological activation. The presence of overlap phenotype in both structural and non-structural groups underscores the concept that CPA and ABPA represent different manifestations along a shared disease spectrum \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eClinically, these findings have important implications. First, they highlight the need for integrated evaluation combining radiological and immunological parameters. Second, they suggest that \u003cem\u003eAspergillus\u003c/em\u003e-related hypersensitivity should be considered even in non-asthmatic patients, particularly in tuberculosis-endemic regions which may improve diagnostic accuracy and guide therapeutic strategies.\u003c/p\u003e \u003cp\u003eHowever, our study has certain limitations. It was a time bound study of 1-year duration. The sample size of specific subgroups, particularly non-structural overlap patients, was small, limiting statistical power. We have not evaluated the cause of bronchiectasis in cases besides TB. Despite these limitations, our study provides important real-world insights into the evolving understanding of \u003cem\u003eAspergillus\u003c/em\u003e-related lung disease.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study demonstrates that CPA\u0026ndash;ABPA overlap represents a dominant phenotype in structurally diseased lungs, with asthma significantly amplifying the immunological response. Recognition of this heterogeneity is essential for accurate classification and personalized management of Aspergillus-related lung disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCPA: chronic Pulmonary Aspergillosis, ABPA: Allergic Broncho pulmonary Aspergillosis, \u0026nbsp; AS: Aspergillus sensitization\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e● Ethics approval and consent to participate: Ethical approval was taken from the institutional Ethics Committee (human) of Assam Medical College\u0026nbsp;No. AMC/EC/2025/2166.\u0026nbsp;Written informed consent was taken from all the participants before inclusion in the study.\u003cbr\u003e● Consent for publication: Consent for publication is taken from the participants.\u003cbr\u003e● Availability of data and materials: Data is available in the paper and also with the first author and the corresponding author . It is available on request.\u003cbr\u003e● Competing Interests: The authors declare that they have no competing interests.\u003cbr\u003e● Funding: This work received no external funding.\u003cbr\u003e● Authors\u0026apos; contributions: SW : Concept, Data collection ,analysis of data ,writing the manuscript, RN: Conceptualized, Analysis of data, Writing the manuscript. PB and JD: Data collection, Analysis of data, Reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDhar R, Singh S, Talwar D, Mohan M, Tripathi SK, Swarnakar R, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India registry. \u003cem\u003eLancet Glob Health\u003c/em\u003e. 2019;7(9):e1269\u0026ndash;79. \u003c/li\u003e\n\u003cli\u003eDe Soyza A, Aliberti S. Bronchiectasis and Aspergillus: how are they linked? \u003cem\u003eMed Mycol\u003c/em\u003e. 2017;55(1):69\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eHashem MK, Nasim YSM, Mohamed-Hussein AAR, Shaddad AM. The clinical and functional characteristics of bronchiectasis among tuberculosis patients in Upper Egypt: a single-center study. \u003cem\u003eEgypt J Bronchol\u003c/em\u003e. 2022;16:15. \u003c/li\u003e\n\u003cli\u003eTiew PY, Thng KX, Chotirmall SH. Clinical Aspergillus signatures in COPD and bronchiectasis. \u003cem\u003eJ Fungi\u003c/em\u003e. 2022;8(5):480. \u003c/li\u003e\n\u003cli\u003eRoboubi A, Audousset C, Fr\u0026eacute;alle \u0026Eacute;, Brun AL, Laurent F, Vitte J, et al. Allergic bronchopulmonary aspergillosis: a multidisciplinary review. \u003cem\u003eJ Med Mycol\u003c/em\u003e. 2023;33(3):101392. \u003c/li\u003e\n\u003cli\u003eAgarwal R, Muthu V, Sehgal IS, Dhooria S, Prasad KT, Aggarwal AN. Allergic bronchopulmonary aspergillosis. \u003cem\u003eClin Chest Med\u003c/em\u003e. 2022;43(1):99\u0026ndash;125. \u003c/li\u003e\n\u003cli\u003eSehgal IS, Dhooria S, Prasad KT, Muthu V, Aggarwal AN, Rawat A, et al. Sensitization to \u003cem\u003eAspergillus fumigatus\u003c/em\u003e in subjects with non-cystic fibrosis bronchiectasis. \u003cem\u003eMycoses\u003c/em\u003e. 2021;64(4):412\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAgarwal R, Sehgal IS, Muthu V, Denning DW, Chakrabarti A, Soundappan K, et al. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. \u003cem\u003eEur Respir J\u003c/em\u003e. 2024;63(4):2400061. \u003c/li\u003e\n\u003cli\u003eDenning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines. \u003cem\u003eEur Respir J\u003c/em\u003e. 2016;47(1):45\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eLozier B, Nguyen MH, Clancy CJ, et al. Determination of positivity cutoff for \u003cem\u003eAspergillus\u003c/em\u003e-specific IgG. \u003cem\u003eJ Appl Lab Med\u003c/em\u003e. 2025;10(3):619\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003ePham TQ, et al. Pulmonary aspergillosis: epidemiology and unresolved issues. \u003cem\u003eMed Mycol\u003c/em\u003e. 2025;63(2):myad012. \u003c/li\u003e\n\u003cli\u003eAgarwal R, Sehgal IS, Muthu V, Dhooria S, Prasad KT, Aggarwal AN, et al. The 2024 ISHAM-ABPA working group guidelines. \u003cem\u003eLung India\u003c/em\u003e. 2025;42(3):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eAgarwal R, Sehgal IS, Muthu V, Denning DW, Chakrabarti A, Soundappan K, et al. Revised diagnostic criteria for allergic bronchopulmonary aspergillosis. \u003cem\u003eEur Respir J\u003c/em\u003e. 2024;63(2):2300934. \u003c/li\u003e\n\u003cli\u003eXu J, et al. Updated clinical practice guidelines for allergic bronchopulmonary aspergillosis/mycosis. \u003cem\u003eEur Respir Rev\u003c/em\u003e. 2024;33(172):230221. \u003c/li\u003e\n\u003cli\u003eZhang M, et al. Allergic bronchopulmonary aspergillosis in non-asthmatic patients: an emerging phenotype. \u003cem\u003eRespir Med Case Rep\u003c/em\u003e. 2026;45:101889. \u003c/li\u003e\n\u003cli\u003eStjepanovic M, et al. Pulmonary aspergillosis in asthma: clinical implications. \u003cem\u003eJ Infect Dev Ctries\u003c/em\u003e. 2025;19(2):123\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eSoundappan K, Muthu V, Dhooria S, Sehgal IS, Prasad KT, Rudramurthy SM, et al. Aspergillus sensitization and allergic bronchopulmonary aspergillosis detection. \u003cem\u003eMycoses\u003c/em\u003e. 2024;67(8):e13784. \u003c/li\u003e\n\u003cli\u003eMSD Manual Professional Version. Allergic bronchopulmonary aspergillosis (ABPA). Available from: https://www.msdmanuals.com \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bronchiectasis, Aspergillus sensitization, ABPA, CPA, Tuberculosis, IgE, IgG","lastPublishedDoi":"10.21203/rs.3.rs-9311724/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9311724/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eBronchiectasis is associated with a spectrum of Aspergillus-related lung diseases, including Aspergillus sensitization (AS), allergic bronchopulmonary aspergillosis (ABPA), and chronic pulmonary aspergillosis (CPA). Data on the immunological profile of these conditions from Northeast India are limited.\u003c/p\u003e\u003ch2\u003eObjectives:\u003c/h2\u003e \u003cp\u003eTo evaluate Aspergillus fumigatus-specific IgE, IgG, and total IgE levels in hospitalized patients with bronchiectasis and to characterize Aspergillus-related disease phenotypes based on serological and clinico-radiological features.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eIn this prospective cross-sectional study, 100 consecutive patients with HRCT-confirmed bronchiectasis were evaluated. Serum Aspergillus fumigatus-specific IgE, IgG, and total IgE were measured using the ImmunoCAP system. AS, ABPA, and CPA were defined using revised ISHAM (2024) and GAFFI/CDC criteria.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAspergillus sensitization was observed in 34% of patients, while elevated Aspergillus-specific IgG was seen in 37%. Combined serological positivity (IgG\u0026thinsp;\u0026gt;\u0026thinsp;27 mg/L, IgE\u0026thinsp;\u0026gt;\u0026thinsp;0.35 kUA/L, and total IgE\u0026thinsp;\u0026ge;\u0026thinsp;500 IU/mL) was present in 14% of patients. Among IgG-positive patients, 37.8% fulfilled combined criteria. Structural lung disease (cavity and/or fungal ball) was present in 64.9% of IgG-positive patients and was significantly associated with overlap phenotype (p\u0026thinsp;\u0026asymp;\u0026thinsp;0.03). Among asthma patients, 47.6% fulfilled ABPA immunological criteria. A subgroup of six patients without structural lung disease demonstrated full immunological positivity, including non-asthmatic individuals.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eAspergillus-related lung disease in bronchiectasis represents a spectrum ranging from infection to hypersensitivity. Structural lung disease and asthma independently contribute to immunological activation, supporting a dual-pathway model. Recognition of this heterogeneity is important for accurate diagnosis and management, particularly in tuberculosis-endemic regions.\u003c/p\u003e","manuscriptTitle":"Aspergillus IgG and IgE in hospitalized patients with bronchiectasis from a tertiary care hospital of eastern Assam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 06:15:01","doi":"10.21203/rs.3.rs-9311724/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T15:03:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T14:54:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263293492696442183900142663617276897508","date":"2026-05-04T09:25:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T14:59:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332846964988260062495176477638478705783","date":"2026-04-30T07:59:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210537806342464992589752757284138995485","date":"2026-04-29T05:12:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T16:39:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-26T22:56:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-09T18:12:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T13:14:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2026-04-09T11:54:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a711b9c3-6743-4785-a08d-58a71842787e","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T15:03:23+00:00","index":71,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T14:54:07+00:00","index":70,"fulltext":""},{"type":"reviewerAgreed","content":"263293492696442183900142663617276897508","date":"2026-05-04T09:25:22+00:00","index":50,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T14:59:45+00:00","index":46,"fulltext":""},{"type":"reviewerAgreed","content":"332846964988260062495176477638478705783","date":"2026-04-30T07:59:14+00:00","index":45,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T06:15:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 06:15:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9311724","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9311724","identity":"rs-9311724","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}