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editorial
. 2011 Mar 17;30(4):361–374. doi: 10.1016/j.healun.2011.01.701

Table 4a.

Fungal Pneumonia in CTTX

Syndromea Signs/symptoms Radiology Laboratory

  • Pneumonia

  • Proven:

  • Histology (biopsy showing histologic evidence of parenchymal invasion by fungal hyphae or pseudohyphae) or positive culture from sterile tissue ALONE; OR with sign/symptoms + radiology + laboratory

  • Probable:

  • Sign/symptoms + radiology + laboratory + negative histology

  • At least one of the following:

  •  • Fever >38°C OR hypothermia <36.5°C with no other recognized cause

  •  • Leukopenia (<4,000 WBC/mm3) OR leukocytosis (≥12,000 WBC/mm3)

  •  • New onset of purulent sputum OR

  •  • Change in character OR quantity of sputum OR respiratory secretions suctioned

  •  • New-onset or worsening cough, dyspnea, tachypnea, or pleural rub, rales or bronchial breath sounds

  •  • Worsening gas exchange (O2 desaturation, PaO2/FIO2 ≤240, increased oxygen requirements or increased ventilation demand)

  •  • Pleural effusion

  • Chest radiograph with:

  •  • New or progressive and persistent infiltrate

  •  • Consolidation

  •  • Cavitation

  •  • Nodules

  • OR CT scan with at least one of the followingb:

  •  • New or progressive and persistent infiltrate

  •  • Consolidation

  •  • Cavitation

  •  • Nodules

 Single positive culture for mold BAL/bloodcOR single positive PCR for mold BAL/blood OR positive galactomannan in the BAL; OR at least TWO positive sputum cultures/PCRs of fungal organisms (excluding Candida species)
a

In the absence of biopsy categorize as probable: In the presence of histologic findings of both acute rejection and fungal invasion it should be classified as acute rejection with proven fungal infection.

b

The presence of mosaic appearance and ground-glass opacity may represent development of bronchiolitis obliterans syndrome or obliterative bronchiolitis.

c

Isolation of non-pathogenic molds in culture (e.g., Cladosporium spp, Phialemonium, Chaetomium, Cunninghamella, Syncephalastrum, Curvularia, Dactylaria, Graphium or Phialophora) or other non-pathogenic fungi [e.g., Penicillium (non-Marnefii), Paecilomyces or basidiomyctes] do not qualify for the “probable” category. They should only be considered in the “proven” category.