Table 2 Classification of ARDS patients with one or more respiratory tract sample positive for Aspergillus spp., according to the Blot algorithm, adapted from Blot et al. [16]
Immunosuppression (n = 17)a | No Immunosuppression (n = 18) | |
|---|---|---|
Proven invasive pulmonary aspergillosis (n = 1) | 1 (6) | 0 (0) |
Putative invasive pulmonary aspergillosis (n = 16) | 11 (65) | 5 (28)b |
1. Aspergillus-positive lower respiratory tract specimen culture | 17 | 18 |
2. Compatible signs and symptoms | ||
Fever refractory to at least 3 d of appropriate antibiotic therapy | 3 | 1 |
Recrudescent fever after a period of defervescence of at least 48 h while still on antibiotics and without other apparent cause | 1 | 0 |
Pleuritic chest pain | 1 | 0 |
Pleuritic rub | 0 | 0 |
Dyspnea | 0 | 0 |
Hemoptysis | 1 | 0 |
Worsening respiratory insufficiency in spite of appropriate antibiotic therapy and ventilatory support | 6 | 11 |
3. Abnormal medical imaging by portable chest X-ray or CT scan of the lungs | 17 | 18 |
4a. Host risk factors | 17 | 0 |
Neutropenia (absolute neutrophil count < 0.5 G/L) preceding or at the time of ICU admission | 4 | 0 |
Underlying hematological or oncological malignancy treated with cytotoxic agents | 5 | 0 |
Glucocorticoid treatment (prednisone equivalent >20 mg/d and >4 weeks) | 1 | 0 |
Congenital or acquired immunodeficiency | 7 | 0 |
4b. Semiquantitative Aspergillus-positive culture of BAL fluid (+ or ++), without bacterial growth together with a positive cytological smear showing branching hyphae | 4 | 6 |
Aspergillus respiratory tract colonization (n = 18) | 5 (29) | 13 (72)c |