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 |