Table 1 Diagnostic criteria for COVID-19-associated pulmonary aspergillosis (CAPA) according to ECMM/ ISHAM [5]
Host factors | Clinical factors | Mycological evidence | |
|---|---|---|---|
Tracheobronchitis or other pulmonary forms (proven) | Patients with COVID-19 needing intensive care and a temporal relationship (entry criterion) | At least one of the following: Histopathological or direct microscopic detection of fungal hyphae, showing tissue damage; or aspergillus recovered by culture or microscopy or histology or PCR obtained by a sterile aspiration or biopsy | |
Tracheobronchitis (probable) | Patients with COVID-19 needing intensive care and a temporal relationship (entry criterion) | Tracheobronchitis, indicated by tracheobronchial ulceration, nodule, pseudomembrane, plaque, or eschar seen on bronchoscopic analysis | At least one of the following: Microscopic detection of fungal elements in bronchoalveolar lavage; positive bronchoalveolar lavage culture or PCR; serum galactomannan index > 0.5 or serum LFA index > 0.5; or bronchoalveolar lavage galactomannan index ≥ 1.0 or bronchoalveolar lavage LFA index ≥ 1.0 |
Other pulmonary forms (probable) | Patients with COVID-19 needing intensive care and a temporal relationship (entry criterion) | Pulmonary infiltrate, preferably documented by chest CT, or cavitating infiltrate (not attributed to another cause) | At least one of the following: Microscopic detection of fungal elements in bronchoalveolar lavage; positive bronchoalveolar lavage culture; serum galactomannan index > 0.5 or serum LFA index > 0.5; bronchoalveolar lavage galactomannan index ≥ 1.0 or bronchoalveolar lavage LFA index ≥ 1.0; two or more positive aspergillus PCR tests in plasma, serum, or whole blood; a single positive aspergillus PCR in bronchoalveolar lavage fluid |
Other pulmonary forms (possible) | Patients with COVID-19 needing intensive care and a temporal relationship (entry criterion) | Pulmonary infiltrate, preferably documented by chest CT, or cavitating infiltrate (not attributed to another cause) | At least one of the following: Microscopic detection of fungal elements in non-bronchoscopic lavage; positive non-bronchoscopic lavage culture; single non-bronchoscopic lavage galactomannan index > 4.5; non-bronchoscopic lavage galactomannan index > 1.2 twice or more; or non-bronchoscopic lavage galactomannan index > 1.2 plus another non-bronchoscopic lavage mycology test positive |