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Table 3 Diagnostic criteria of invasive aspergillosis in patients with acute respiratory distress syndrome related to Coronavirus disease 19 (C-ARDS) or other viruses (NC-ARDS)

From: Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease

  NC-ARDS (n = 82) C-ARDS (n = 90) p value
IAPA case definition    
Proven invasive pulmonary aspergillosis: Biopsy or brush specimen of airway plaque, pseudomembrane, or ulcer showing hyphal elements and Aspergillus growth on culture or positive Aspergillus PCR on tissue. Lung biopsy showing invasive fungal elements and Aspergillus growth on culture or positive Aspergillus PCR on tissue 0 0  
Probable invasive pulmonary aspergillosis 17 (21%) 7 (8%) 0.01
Probable invasive pulmonary aspergillosis diagnosed at ICU admission 9 (53%) 3 (43%)  
Time from admission to diagnosis of probable pulmonary aspergillosis during ICU stay, days 10 [7–14] 6 [5–11]  
Aspergillus tracheobronchitis 1 (1%) 1 (1%) 0.95
Airway plaque, pseudomembrane, or ulcer 3/49 1/24  
IAPA in patients without documented Aspergillus tracheobronchitis 16 (20%) 6 (7%) 0.01
Pulmonary infiltrate 82 90  
Cavitating infiltrate (not attributed to another cause) 1 1  
Serum GM index > 0.5 6/40 5/88  
BAL GM index ≥ 1.0 5/31 0/0  
Positive BAL culture 10/50 4/24  
Crude AspICU criteria    
Proven invasive pulmonary aspergillosis: 0 0  
Putative invasive pulmonary aspergillosis 12 (15%) 2 (2%) 0.003
1. Aspergillus-positive lower respiratory tract specimen culture* 17 6  
2. Compatible signs and symptoms 16 6  
3. Abnormal medical imaging by portable chest X-ray or CT-scan 14 5  
4a. Host risk factors 9 0  
4b. Semiquantitative Aspergillus-positive culture of BAL fluid (+ or ++), without bacterial growth together with a positive cytological smear showing branching hyphae 8 2  
Colonization 5 (6%) 4 (5%) 0.63
Modified AspICU criteria    
Proven invasive pulmonary aspergillosis: 0 0  
Putative invasive pulmonary aspergillosis 15 (18%) 6 (7%) 0.02
Mycological criteria 18 7  
Histopathology or direct microscopic evidence of dichotomous septate hyphae with positive culture for Aspergillus on tissue 0 0  
Serum GM index > 0.5 6/40 5/88  
BAL GM index ≥ 1.0 5/31 0/0  
Positive BAL culture 10/50 4/24  
Compatible signs and symptoms§ 17/18 6/7  
Abnormal medical imaging by portable chest X-ray or CT-scan§ 16/18 7/7  
Other diagnostic criteria    
Aspergillus PCR on lower respiratory tract: positive cases / performed cases 0 /7 (0%) 16 /81(20%)  
1,3-β-D-glucan: positive cases /performed cases 8/23(35%) 9 /88(10%)  
  1. *Entry criterion for Crude AspICU criteria. Data are n (%) or n/N (%). BAL bronchoalveolar lavage
  2. §Among patients with positive mycological criteria