Table 1.

Clinical algorithm for the diagnosis of invasive aspergillosis in non-neutropenic patients

Proven invasive pulmonary aspergillosis
●	Follow EORTC/MSG criteria
Putative invasive pulmonary aspergillosis (all four criteria must be met)
●	1. Aspergillus-positive lower respiratory tract specimen culture
●	2. Compatible signs and symptoms (one of the following)
	Fever refractory to at least 3 days of appropriate antibiotic therapy
	Recrudescent fever after a period of defervescence of at least 48 hours while still on antibiotics and without other apparent cause
	Pleuritic chest pain
	Pleuritic rub
	Dyspnea
	Hemoptysis
	Worsening respiratory insufficiency in spite of appropriate antibiotic therapy and ventilatory support
●	3. Abnormal medical imaging by portable chest X-ray or CT scan of the lungs
●	4. Either 4a or 4b
	4a. Host risk factors (one of the following conditions)
	Neutropenia preceding or at the time of ICU admission
	Underlying hematological or oncological malignancy treated with cytotoxic agents
	Glucocorticoid treatment (prednisone equivalent, 20 mg/day)
	Congenital or acquired immunodeficiency
	COPD, decompensated cirrhosis
	4b. Semiquantitative Aspergillus -positive culture of BAL fluid without bacterial growth together with a positive cytological smear showing branching hyphae
Aspergillus respiratory tract colonization
●	When >1 criterion necessary for a diagnosis of putative IPA is not met, the case is classified as Aspergillus colonization

BAL, bronchoalveolar lavage; COPD, chronic obstructive pulmonary disease; CT, computed tomography; EORTC/MSG, European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group; IPA, invasive pulmonary aspergillosis.