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

Table 4b.

Fungal Tracheobronchitis in CTTX

Syndromea Signs/symptoms Radiology Laboratory

  • Tracheobronchitis

  • Proven:

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

  • Probable:

  • Sign/symptoms + radiology + laboratory + negative histology

  • At least one of the following:

  •  • New-onset of purulent sputum OR change In character OR quantity of sputum /respiratory secretions suctioned

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

  • AND one or more endobronchial lesions (erythema, ulceration, necrosis and pseudomembrane formation including at the site endobronchial stent) without an alternative diagnosis and without evidence of invasive parenchymal disease (Figure 1c)

  • Chest radiograph without:

  •  • New or progressive and persistent infiltrate

  •  • Consolidation

  •  • Cavitation

  •  • Nodules

  • OR CT scan without:

  •  • New or progressive and persistent infiltrate

  •  • Consolidation

  •  • Cavitation

  •  • Nodules

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

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

a

In the absence of biopsy categorized 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

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.