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

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

Imaging

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