Hamam et al reported a clinical algorithm for predicting pulmonary aspergillosis in a patient in the intensive care unit (ICU). This can allow for prompt antifungal therapy. The authors are from multiple institutions in France.
Patient selection: patient in the ICU
Entry criterion - one or more of the following:
(1) imaging findings suspicious for pulmonary Aspergillosis
(2) clinical sign (respiratory deterioration or fever after antibiotics >= 3 days)
(3) identification of Aspergillus in the lower respiratory tract on culture
Primary criteria:
(1) >= 1 EORTC/MSGERC-2008 host factors (ANC < 500 per µL for > 10 days; receipt of allogeneic stem cell transplant; corticosteroid therapy > 0.3 mg per kg per day for > 3 weeks; therapy with T-cell immunosuppressant for > 90 days; inherited immunodeficiency; ibrutinib therapy; underlying cancer treated with cytotoxic agents)
(2) >= 1 imaging criterion (CT scan of lung; air-crescent sign; cavity; dense well-circumscribed lesion with or without halo sign)
(3) >= 1 mycological criterion (positive direct exam showing hyphae; positive Aspergillus culture on bronchoalveolar lavage fluid; positive Aspergillus culture on lower lobe biopsy)
Alternatively, all of the following:
(1) >= 1 other risk factor (COPD; viral respiratory disease; cirrhosis; liver failure; diabetes; chronic alcohol use, cardiac surgery)
(2) >=1 imaging criterion (see above plus diffuse reticular and alveolar opacities)
(3) >= 1 clinical criterion (pleuritic chest pain; dyspnea; hemoptysis; respiratory insufficiency despite ventilation support; fever refractory to > 3 days of antibiotic therapy)
(4) >= 2 mycological criteria (Aspergillus qPCR in serum, aspergillus qPCR in bronchoalveolar lavage fluid; blood galactomannan; bronchoalveolar fluid galactomannan)
If the patient meets either pathway, then invasive pulmonary Aspergillosis is probable?
If neither pathway is met, then it may represent colonization, contamination, or early invasive disease.
