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: ① Fever refractory to at least three days of appropriate antibiotic therapy. ② Recrudescent fever after a period of defervescence of at least 48 h while still on antibiotics and without other apparent cause. ③ Pleuritic chest pain. ④ Pleuritic rub. ⑤ Dyspnea. ⑥ Haemoptysis. ⑦ 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. |