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Table 4 Modified Bulpa criteria for probable IPA in critically Ill COPD patients admitted to an ICU

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

Criteria for diagnosing probable IPA in critically ill COPD patients admitted to ICU

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

  1. *,#: A serum galactomannan test greater than 0.5 ng/ml and BALF galactomannan test greater than 0.8 ng/ml were defined as a positive result
  2. Note: The diagnose of probable IPA could be made when a critically ill COPD patients in ICU with a pulmonary functional level of GOLD III or IV, a history of steroid use for at least 3 months and appropriate compatible signs or symptoms, having any major radiological sign of pneumonia and one of the microbiological findings.
  3. IPA Invasive Pulmonary Aspergillus; COPD Chronic Obstructive Pulmonary Disease; ICU Intensive Care Unit; GOLD Global Initiative for Chronic Obstructive Lung Disease; CT Computed Tomography; LRT Lower Respiratory Tract; BALF Bronchoalveolar Lavage Fluid; GM Galactomannan