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Table 1 Diagnostic criteria for invasive pulmonary aspergillosis according to EORTC/MSGERC-2008, EORTC/MSGERC-2019, AspICU and BM-AspICU

From: New clinical algorithm including fungal biomarkers to better diagnose probable invasive pulmonary aspergillosis in ICU

  Host risk factors (immunosuppression)
Neutropenia (< 500 neutrophils/mm3 for > 10 days) X X X X
Receipt of an allogenic stem cell transplant X X X X
Corticosteroids > 0.3 mg/kg/day for > 3 weeks X X X X
Treatment with recognized T-cell immunosuppressant for more than 90 days X X X X
Inherited severe deficiency X X X X
Underlying hematological or oncological malignancy treated with cytotoxic agents X X X X
Ibrutinib treatment   X X X
  Other risk factors
Chronic obstructive pulmonary disease    X X
Viral respiratory diseases (influenza infection, SARS-CoV2 infection, etc.)    X X
Cirrhosis, hepatic insufficiency    X X
Other (diabetes, chronic alcohol abuse, chronic diseases, cardiac surgery, etc.)    X X
  Clinical features
Fever refractory to > 3 days of antibiotherapy    X X
Pleuritic chest pain    X X
Dyspnea    X X
Hemoptysis    X X
Respiratory insufficiency despite ventilation support    X X
CT scan of the lung X X X X
Chest X-ray    X X
Air-crescent sign X X X X
Cavity X X X X
Dense, well-circumscribed lesion(s) with or without halo sign X X X X
Diffuse reticular and alveolar opacities   X X X
Nonspecific infiltrates and consolidation   X X X
Pleural fluid    X X
Wedge-shaped infiltrate   X X X
Tree-in-bud pattern    X X
  Mycological culture
Positive direct examination showing hyphae X X X X
Positive Aspergillus culture in BALF X X X X
Positive Aspergillus culture in lower respiratory tract specimen X X X X
  Fungal biomarkers
BALF galactomannan X X   X
BALF Aspergillus qPCR   X*   X
Serum/plasma galactomannan X X   X
Serum/plasma Aspergillus qPCR   X*   X
  1. * Two consecutive qPCR tests positive in blood, or one qPCR test positive in blood and one qPCR test positive in BALF