Criteria for Diagnosis of Invasive Aspergillosis

 

Definitive for invasive aspergillosis - one of the following:

(1) positive culture from a site AND histologic evidence of invasive disease from a biopsy taken at the same site

(2) positive culture taken by an invasive technique from a normally sterile site

 

Probable invasive aspergillosis - both of the following:

(1) appropriate host, as listed below

(2) identification of Aspergillus, as listed below

(3) procedure to make a definitive diagnosis contraindicated

 

An appropriate host may have one or more of the following:

(1) absolute neutropenia (< 500 per µL)

(2) recent therapy with cytotoxic agent(s)

(3) glucocorticoid therapy equivalent to > 20 mg prednisone per day

(4) immunodeficiency (congenital, acquired)

 

Identification of Aspergillus by one or more of the following:

(1) 2 or more sputum cultures positive for same species

(2) 2 or more throat cultures positive for the same species

(3) 1 or more bronchoscopy specimens positive by culture or smear

(4) evidence of invasive Aspergillosis in another organ system

 

Possible invasive aspergillosis:

(1) cytotoxic therapy for leukemia (possibly other appropriate hosts, as listed above)

(2) procedure to make a definitive diagnosis contraindicated or results of procedure negative

(3) presence of 5 or more clinical findings

 

Clinical findings that may indicate possible invasive aspergillosis:

(1) temperature >= 38°C on admission (>= 100°F)

(2) absolute neutropenia for > 30 days

(3) >= 2 febrile episodes of unknown source (>= 38°C, >= 100°F)

(4) febrile episode of unknown source for >= 14 days

(5) fever for >= 19 days while receiving antibiotic therapy (assuming appropriate)

(6) rales without fluid overload

(7) presence of a nasal eschar or ulcer or discharge with epistaxis plus sinus tenderness

(8) pleuritic chest pain

(9) chest infiltrate first seen on radiograph after hospital day 14

(10) pulmonary infiltrate in 2 or more lobes

(11) chest X-ray showing nodules or cavities

 

Colonization: presence of Aspergillus species on culture but not associated with clinical disease