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Table 1 Brief descriptions of each diagnostic criteria

From: Is Bulpa criteria suitable for the diagnosis of probable invasive pulmonary Aspergillosis in critically ill patients with chronic obstructive pulmonary disease? A comparative study with EORTC/ MSG and ICU criteria

 

EORTC/ MSG Criteria

Bulpa Criteria

ICU Criteria

Host factors

i) A recent history of neutropenia (<0.5*109 neutrophils/L for more than 10 days) that is temporally related to the onset of fungal disease.

ii) Receipt of an allogeneic stem cell transplant.

iii) Prolonged use of corticosteroids at a mean minimum dose of 0.3 mg/kg/day of a prednisone equivalent for more than 3 weeks.

iv) Treatment with other recognized T cell immunosuppressants, such as cyclosporine, TNF-α blockers, specific monoclonal antibodies or nucleoside analogues during the previous 90 days.

v) Inherited severe immunodeficiency.

i) Patients with a pulmonary functional level of stage III or IV according to the GOLD guidelines.

ii) Patients treated with steroids, with no strict requirement regarding the usage, dosage or duration.

i) Neutropenia (absolute neutrophil count < 500/mm3) preceding or at the time of ICU admission.

ii) Underlying haematological or oncological malignancy treated with cytotoxic agents.

iii) Glucocorticoid treatment (prednisone equivalent, >20 mg/d).

iv) Congential or acquired immunodeficiency.

Clinical data

Patients must have subjected to at least one CT scan and must exhibit 1 of the following 3 signs:

i) Dense, well-circumscribed lesion(s) with or

without a halo sign.

ii) An air-crescent sign.

iii) A cavity.

i) Patients with recent exacerbation of dyspnea despite the administration of appropriate antibiotics.

ii) Patients with progressive deterioration of chest imaging findings (within three months)

i) One of the following compatible signs or symptoms:

Fever refractory to at least three days of appropriate antibiotic therapy.

Recrudescent fever after a period of defervescence of at least 48 h while still on antibiotics and without other apparent cause.

Pleuritic chest pain.

Pleuritic rub.

Dyspnea.

Haemoptysis.

Worsening respiratory insufficiency despite appropriate therapy and ventilator support.

ii) Patients with abnormal chest X rays (CXRs) or CTs.

Mycological findings

i) Positive culture and/or microscopy result for Aspergillus from the lower respiratory tracts (LRTs).

ii) Positive serum or bronchoalveolar lavage fluid (BALF) galactomannan (GM) tests.

i) Positive culture and/or microscopy findings for Aspergillus from the LRTs.

ii) Positive serum antibody test for A. fumigatus (including precipitin).

iii) Two consecutive positive serum GM tests.

Positive culture for Aspergillus from the LRTs.

  1. Note: We concluded each criteria as three parts, namely the host factors, clinical data and microbiological findings and marked the main differences among three criteria italic and underline. EORTC/MSG European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group; ICU Intensive Care Unit; TNF-α: Tumor Necrosis Factor-α; CT Computed Tomography; CXR Chest X Ray; LRT Lower respiratory tract; BALF Bronchoalveolar Lavage Fluid; GM Galactomannan