Criteria for diagnosing probable IPA in critically ill COPD patients admitted to ICU |
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1. Host factors ( the following at the same time) |
i) Pulmonary function: A level of GOLD III or IV |
ii) Steroid: treated with systemic steroid use, with no specific requirement regarding dose or course; or treated with an inhaled steroid for at least 3 months |
2. Compatible Signs or Symptoms (one of the following) |
i) Fever refractory to at least three days of appropriate antibiotic therapy ii) Recrudescent fever after a period of defervescence at least 48 h while still on antibiotics and without other apparent cause iii) Recent dyspnea or hemoptysis iv) Worsening respiratory insufficiency despite appropriate therapy and ventilator support |
3. Radiological Findings (one of the following) |
Abnormal imaging on CT or X-ray, within three month i) Nonspecific infiltrates and patchiness ii) Multiple nodules distributed along the airway ii)Well- shaped nodule(s), with or without halo sign iv)Wedge-shaped consolidation v) Mass consolidation vi) Air-crescent sign vii) Cavitation |
4. Mycological Data (one of the following) |
i) Positive culture and/or microscopy for Aspergillus from LRTs ii) Two consecutive positive serum/BALF GM tests*,# iii) One positive BALF test and one positive serum GM test |