Bulpa et al reported criteria for the diagnosis of invasive pulmonary aspergillosis (IPA) in a patient with chronic obstructive pulmonary disease (COPD).
Patient selection: chronic obstructive pulmonary disease (COPD)
Proven invasive pulmonary aspergillosis - all of the following:
(1) histopathological or cytopathological evidence of hyphae consistent with Aspergillus species
(2) specimen taken from a pulmonary lesion present < 3 months
(3) evidence of tissue damage
(4) any of the following
(4a) positive culture of Aspergillus species from lower respiratory tract
(4b) positive serum antibody test for A. fumigatus (including precipitins)
(4c) confirmation that hyphae are those of Aspergillus (molecular, immunohistochemical)
Probable invasive pulmonary aspergillosis - one of the following:
(1) items 1, 2 and 3from proven IPA (above)
(2) COPD patient stage III or IV GOLD functional level
(2a) recent exacerbation of dyspnea
(2b) chest imaging findings suggestive of aspergillosis
(2c) present for less than 3 months
(2d) one or more of the following:
(2d1) positive culture and/or microscopy for Aspergillus from a lower respiratory tract specimen
(2d2) positive serum antibody test for A, fumigatus (including precipitins)
(2d3) 2 consecutive positive galactomannan test
Possible invasive pulmonary aspergillosis:
(1) COPD treated with corticosteroids with items 2a through 2c from probable IPA (above)
Colonisation - all of the following:
(1) COPD without exacerbation of dyspnea or bronchospasm
(2) no new pulmonary infiltrate
(3) positive Aspergillus culture form the lower respiratory tract
