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Table 1 Criteria for defining cases of invasive pulmonary aspergillosis

From: Clinical relevance of Aspergillus isolation from respiratory tract samples in critically ill patients

Definite invasive pulmonary aspergillosis
   A. Positive result of histological testing and positive result of culture from lung tissue obtained by biopsy or autopsy
   B. Positive result of culture of a specimen obtained from a normally sterile site by use of aseptic invasive technique
Probable invasive pulmonary aspergillosis
   1. Aspergillus-positive lower respiratory tract specimen culture
   2. Compatible signs and symptoms
Fever refractory to at least three days of appropriate antibiotic therapy
Recrudescent fever after a period of defervescence of at least 48 hours while still on antibiotics and without other apparent cause
Pleuritic chest pain
Pleuritic rub
Dyspnoea
Hemoptysis
Worsening respiratory insufficiency in spite of appropriate antibiotic therapy and ventilatory support
   3. Abnormal medical imaging by portable chest X-ray or computerised tomography of the lungs
   4. Either
a. Host risk factors: one of the following conditions
Neutropenia (absolute neutrophil count less then 500/mm3) preceding or at the time of ICU admission
Underlying haematological or oncological malignancy treated with cytotoxic agents
Glucocorticoid treatment (prednisone or equivalent, >20 mg/day)
Congenital or acquired immunodeficiency
   Or
b. Semiquantitative Aspergillus-positive culture of BAL (+ or ++), without bacterial growth together with a positive cytological smear showing branching hyphae
Aspergillus colonisation
   Not fullfulling the criteria for proven or probable invasive pulmonary aspergillosis
  1. ICU, intensive care unit; BAL, broncho-alveolar lavage.