Table 3.

Proposed Diagnostic Criteria for Fungal Colonization and Active Infection

Criteria	Colonization	Infection
Major criteria
Microbiology	Minimum of 2 cultures within 12 months
Clinical symptoms	None	New s/sx and/or worsening lung function
Exclude fungal allergy	No evidence of ABPA or Aspergillus sensitization
Bacterial organism	May be present	May be present as comorbidity
Chest imaging	No change	New infiltrate or airway thickening
Response to antibiotics	Clinical improvement	None
Response to antifungal therapy	None	Clinical improvement
Minor criteria
Specific Fungal IgG	Negative or results within normal range	Elevated
GM (sputum or BAL)	Negative	Positive
Bronchoscopy   BAL   Endobronchial biopsy   Transbronchial biopsy	Fungi within alveolar macrophages or airway/alveolar exudates	Fungi within alveolar macrophages or airway/alveolar exudates Mucosal erythema and/or ulceration Invasion of mucosa by fungal hyphae with acute inflammation

Note: Data from Tracy and Moss.⁴ Abbreviations: ABPA, allergic bronchopulmonary aspergillosis; BAL, bronchoalveolar lavage; IgG, immunoglobulin G; GM, galactomannan; s/sx, signs and symptoms.