Vandewoude et al reported criteria for the interpretation of a positive culture with an Aspergillus species from the lungs of a patient in the intensive care unit (ICU). The authors are from Ghent University and Hogeschool Gent in Belgium.
Definite diagnosis - one of the following:
(1) positive histologic findings AND positive culture from lung tissue
(2) positive culture from a normally sterile site in the lungs using an aseptic invasive technique
Probable - all of the following:
(1) positive culture from a lower respiratory tract specimen
(2) one or more of the following:
(2a) fever refractory to >= 3 days of appropriate antibiotic therapy
(2b) recrudescent fever after a period of defervescence of at least 48 hours while still on antibiotics and without apparent cause
(2c) pleuritic chest pain
(2d) pleuritic rub
(2e) dyspnea
(2f) hemoptysis
(2g) worsening respiratory insufficiency in spite of appropriate antibiotic therapy and ventilatory support
(3) abnormal imaging studies of the lung
(4) one of the following:
(4a) absolute neutrophil count < 500 per µL
(4b) underlying malignancy treated with cytotoxic agents
(4c) glucocorticoid therapy with> 20 mg/day prednisone equivalent
(4d) congenital or acquired immunodeficiency
(4e) semiquantitative culture from BAL without bacterial growth and with cytology showing branching hyphae
where:
• Probable item 1 overlaps with Probable item 4e, the difference being the cytology findings.
If the patient does not meet criteria for either definite or probable, then a positive culture may indicate colonization.
