Table 1.

Diagnostic schemes and criteria used to define various spectrum of diseases caused by Aspergillus spp 

Criteria used	Details	Comment	Reference
Consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC-MSG): invasive aspergillosis in immunocompetent or immunocompromised patient	Proven IA: histopathologic, cytopathologic, or direct microscopic demonstration or culture from sterile aspiration or biopsy specimen with associated tissue damage. Positive PCR with DNA sequencing from FFPE tissue Probable IA (immunocompromised patients): presence of one each of: 1. Host factor like neutropenia, transplantation, and immunosuppressant use 2. Clinical feature or pulmonary, sino-nasal, or CNS infection 3. Mycological evidence, e.g., galactomannan antigen, Aspergillus PCR	• There is a paucity of data to support the clinical application of nonculture-based fungal biomarkers such as the GM test • The ISHAM-working group FPCRI has made progress on developing an Aspergillus PCR standard • The GM test for IA is rendered ineffective when exposed to mold-active antifungals	[30]
Bulpa Criteria: in COPD patient with GOLD stage III or IV, with recent exacerbation of dyspnea	Suggestive chest imaging and one of the following: 1. Positive microscopy/or culture for Aspergillus from lower respiratory tract 2. Positive serum antibody test (including precipitins) for A. fumigatus 3. Two consecutive positive serum galactomannan tests		[31]
Modified AspICU criteria: in ICU patients	One positive blood biomarker (PCR and/or GM) and > 1 criterion among the following: 1. Endotracheal aspirate: repeated culture/PCR positive 2.Compatible clinical signs 3. Chest radiography — abnormal 4.4a. Underlying host risk factors or 4b. Direct microscopy positive + BAL: semiquantitative culture/PCR positive for Aspergillus		[32]
Influenza-associated pulmonary aspergillosis (IAPA)	Airway plaque, pseudomembrane, or ulcer and at least one of the following: 1. Serum GM index > 0.5 2.BAL GM index ≥ 1.0 3. Positive BAL culture 4. Endo-tracheal aspirate culture: positive 5. Sputum culture: positive 6.Hyphae consistent with Aspergillus	May include probable Aspergillus tracheobronchitis or IAPA without documented Aspergillus tracheobronchitis	[33]
Patient with COVID-19 needing intensive care and a temporal relationship — COVID-associated pulmonary aspergillosis (CAPA)	Pulmonary infiltrate, not attributed to another cause (probable pulmonary IA) or tracheobronchial ulceration, pseudomembrane, nodule, eschar, or plaque (Probable tracheobronchitis) And at least one: 1. BAL: microscopic demonstration of fungal elements 2.BAL culture: positive 3. Serum GMI > 0·5 4. Serum LFA index > 0·5 5. BAL GMI ≥ 1·0 6. BAL LFA index ≥ 1·0 7. Plasma, serum, whole blood, or BAL: positive Aspergillus PCR		[34••]
Chronic pulmonary aspergillosis (CPA)	CPA is defined as illness for > 3 months and all of the following: 1. Persistent cough, hemoptysis, and/or weight loss 2. Chest radiography: progressive cavitary infiltrates and/or peri-cavitary fibrosis or infiltrates or pleural thickening and/or fungal ball 3. Positive Aspergillus IgG assay or other evidence of Aspergillus infection		[35]
Allergic bronchopulmonary aspergillosis in patients with asthma: modified ISHAM-ABPA working group criteria	Predisposing condition: presence of asthma or cystic fibrosis Presence of both: 1. A. fumigatus specific IgE > 0.35 kUA/L 2. Serum total IgE > 500 IU/mL And two of the following 1. A. fumigatus specific IgG > 27 mgA/L 2. Peripheral blood eosinophil count > 500/µL 3. CT thorax: high attenuation mucus (ABPA-HAM); bronchiectasis (ABPA-B) or normal findings (ABPA-S)	Earlier, the Rosenberg-Patterson criteria were the most commonly used for ABPA diagnosis but there was no agreement on the number of criteria needed and the cut-off value immunological tests were not specified	[36]
Bent and Kuhn criteria — allergic fungal rhinosinusitis	Major criteria: 1. History of type I hypersensitivity 2. Nasal polyposis 3. Characteristic CT findings 4. Eosinophilic mucin without invasion 5. Positive fungal stain of sinus contents Minor criteria: history of asthma, unilateral predominance of disease, radiological imaging showing evidence of bone erosion, positive fungal cultures, serum eosinophilia and presence of Charcot-Leyden crystals in surgical specimens	Patients must meet all the major criteria for diagnosis	[37]

Abbreviations: BAL: Broncho-alveolar lavage; CT: Computed tomography; CNS: central nervous system; COPD: Chronic Obstructive Pulmonary Disease; DNA: deoxyribonucleic acid; FFPE: Formalin-Fixed Paraffin-Embedded; FPCRI: Fungal PCR initiative; GM: Galactomannan; GMI: Galactomannan Index; GOLD: Global Initiative for Chronic Obstructive Lung Disease; IA: Invasive aspergillosis; IV: Intravenous; LFA: Lateral flow assay; ISHAM: International Society for Human & Animal Mycology; PCR: Polymerase chain reaction