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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.