Table 3.
Diagnostic criteria of invasive aspergillosis in patients with acute respiratory distress syndrome related to Coronavirus disease 19 (C-ARDS) or other viruses (NC-ARDS)
| NC-ARDS (n = 82) | C-ARDS (n = 90) | p value | |
|---|---|---|---|
| IAPA case definition | |||
| Proven invasive pulmonary aspergillosis: Biopsy or brush specimen of airway plaque, pseudomembrane, or ulcer showing hyphal elements and Aspergillus growth on culture or positive Aspergillus PCR on tissue. Lung biopsy showing invasive fungal elements and Aspergillus growth on culture or positive Aspergillus PCR on tissue | 0 | 0 | |
| Probable invasive pulmonary aspergillosis | 17 (21%) | 7 (8%) | 0.01 |
| Probable invasive pulmonary aspergillosis diagnosed at ICU admission | 9 (53%) | 3 (43%) | |
| Time from admission to diagnosis of probable pulmonary aspergillosis during ICU stay, days | 10 [7–14] | 6 [5–11] | |
| Aspergillus tracheobronchitis | 1 (1%) | 1 (1%) | 0.95 |
| Airway plaque, pseudomembrane, or ulcer | 3/49 | 1/24 | |
| IAPA in patients without documented Aspergillus tracheobronchitis | 16 (20%) | 6 (7%) | 0.01 |
| Pulmonary infiltrate | 82 | 90 | |
| Cavitating infiltrate (not attributed to another cause) | 1 | 1 | |
| Serum GM index > 0.5 | 6/40 | 5/88 | |
| BAL GM index ≥ 1.0 | 5/31 | 0/0 | |
| Positive BAL culture | 10/50 | 4/24 | |
| Crude AspICU criteria | |||
| Proven invasive pulmonary aspergillosis: | 0 | 0 | |
| Putative invasive pulmonary aspergillosis | 12 (15%) | 2 (2%) | 0.003 |
| 1. Aspergillus-positive lower respiratory tract specimen culture* | 17 | 6 | |
| 2. Compatible signs and symptoms | 16 | 6 | |
| 3. Abnormal medical imaging by portable chest X-ray or CT-scan | 14 | 5 | |
| 4a. Host risk factors | 9 | 0 | |
| 4b. Semiquantitative Aspergillus-positive culture of BAL fluid (+ or ++), without bacterial growth together with a positive cytological smear showing branching hyphae | 8 | 2 | |
| Colonization | 5 (6%) | 4 (5%) | 0.63 |
| Modified AspICU criteria | |||
| Proven invasive pulmonary aspergillosis: | 0 | 0 | |
| Putative invasive pulmonary aspergillosis | 15 (18%) | 6 (7%) | 0.02 |
| Mycological criteria | 18 | 7 | |
| Histopathology or direct microscopic evidence of dichotomous septate hyphae with positive culture for Aspergillus on tissue | 0 | 0 | |
| Serum GM index > 0.5 | 6/40 | 5/88 | |
| BAL GM index ≥ 1.0 | 5/31 | 0/0 | |
| Positive BAL culture | 10/50 | 4/24 | |
| Compatible signs and symptoms§ | 17/18 | 6/7 | |
| Abnormal medical imaging by portable chest X-ray or CT-scan§ | 16/18 | 7/7 | |
| Other diagnostic criteria | |||
| Aspergillus PCR on lower respiratory tract: positive cases / performed cases | 0 /7 (0%) | 16 /81(20%) | |
| 1,3-β-D-glucan: positive cases /performed cases | 8/23(35%) | 9 /88(10%) |
*Entry criterion for Crude AspICU criteria. Data are n (%) or n/N (%). BAL bronchoalveolar lavage
§Among patients with positive mycological criteria