Table I.

Diagnostic criteria for COVID-19-associated pulmonary aspergillosis (CAPA) according to various studies included in our review

Diagnostic criteria	Clinical	Radiological	Mycological
EORTC/MSG [17]	One of the following host factors: (A) severe neutropenia, (B) allogeneic stem cell/solid organ transplant, (C) corticosteroid therapy (0.3 mg/kg per day for >3 months), (D) haematological malignancy, (E) congenital/inherited/acquired immunodeficiency, (F) treatment with T-cell/B-cell immunosuppressants	One of the following: (A) dense, well-circumscribed lesions with/without halo sign, (B) air-crescent sign, (C) cavity, (D) lobar or segmental consolidation	Proven: histopathological/microscopic evidence of septated hyphae with evidence of tissue damage or positive culture from sterile material Probable (all 3 criteria): (A) positive direct test (culture/microscopy on sputum, ETA, and BAL or 2 and more positive PCR on either BAL or serum), OR (B) positive indirect test (GM in serum or BAL)
AspICU [13]	One of the following: (A) refractory fever despite 3 days of antibiotic therapy, (B) recrudescent fever of at least 48 h despite antibiotic therapy, (C) pleuritic chest pain/rub, dyspnea, (D) haemoptysis, (E) worsening respiratory failure despite antibiotic therapy and ventilatory support	Abnormal imaging on chest radiography or chest CT	Proven: histopathological/microscopic evidence of septated hyphae with evidence of tissue damage or positive culture from sterile material Putative (all 3 criteria): (A) positive lower respiratory tract specimen in patient with either host risk factors (severe neutropenia, haematological/oncological malignancy treated with cytotoxic agents, corticosteroid therapy (prednisone equivalent, >20 mg/day), congenital/acquired immunodeficiency) OR (B) semiquantitative positive BAL culture in the absence of bacterial growth
CAPA-European Excellence Centre for Medical Mycology [14]	One of the following: (A) refractory fever despite 3 days of antibiotic therapy, (B) pleuritic chest pain/rub, dyspnea, (C) haemoptysis	Abnormal imaging on chest radiography or chest CT	Proven: histopathological/microscopic evidence of septated hyphae with evidence of tissue damage or positive culture from sterile material Probable (all 3 criteria): (A) positive lower respiratory tract specimen on BAL OR (B) BAL GM >1.0 ODI OR (C) serum GM >0.5 ODI OR (D) positive serum and BAL PCR, OR (E) positive serum PCR × 2 Possible (all 3 criteria): (A) positive non-BAL lower respiratory tract specimen OR (B) positive non-BAL GM >4.5 ODI OR (C) positive non-BAL GM >1.2 ODI × 2, OR (D) positive non-BAL GM >1.2 ODI with non-BAL PCR
Modified AspICU-Gangneux et al. [15]	One of the following: (A) refractory fever despite 3 days of antibiotic therapy, (B) recrudescent fever of at least 48 h despite antibiotic therapy, (C) pleuritic chest pain/rub, dyspnea, (D) haemoptysis, (E) worsening respiratory failure despite antibiotic therapy and ventilatory support	Abnormal imaging on chest radiography or chest CT	Proven: histopathological/microscopic evidence of septated hyphae with evidence of tissue damage or positive culture from sterile material Putative (all 3 criteria): (A) positive lower respiratory tract specimen in patient with either host risk factors (severe neutropenia, haematological/oncological malignancy treated with cytotoxic agents, corticosteroid therapy (prednisone equivalent, >20 mg/day), congenital/acquired immunodeficiency), OR (B) semiquantitative positive BAL culture/PCR in the absence of bacterial growth Probable: putative plus one positive serum biomarker
Modified AspICU–Dutch/Belgian Mycosis Study Group [10]	One of the following: (A) refractory fever despite 3 days of antibiotic therapy, (B) recrudescent fever of at least 48 h despite antibiotic therapy, (C) pleuritic chest pain/rub, dyspnea, (D) haemoptysis, (E) worsening respiratory failure despite antibiotic therapy and ventilatory support	Abnormal imaging on chest radiography or chest CT	Proven: histopathological/microscopic evidence of septated hyphae with evidence of tissue damage or positive culture from sterile material Putative (all 3 criteria): (A) positive BAL culture, OR (B) BAL GM >1.0 ODI, OR (C) serum GM >0.5 ODI
Influenza-Associated Pulmonary Aspergillosis (IAPA)–Verweij et al. [16]	Influenza-like illness between 7 days before and 4 days after ICU admission	Probable: (A) pulmonary infiltrate and at least one of the following mycological criteria, OR (B) cavitating infiltrate (not attributed to another aetiology) and at least one of the following mycological criteria	Positive influenza PCR/antigen test Proven: histopathological/microscopic evidence of septated hyphae with evidence of tissue damage or positive PCR in tissue Probable (all 3 criteria): (A) pulmonary infiltrate and at least one of the following mycological criteria (serum GM >0.5 ODI, BAL GM >1.0 ODI, positive BAL culture), OR (B) cavitating infiltrate (not attributed to another etiology) and at least one of the following mycological criteria (positive sputum/tracheal aspirate culture)

BAL, bronchoalveolar lavage; 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; ETA, endotracheal aspirate; GM, galactomannan; IAPA, influenza-associated pulmonary aspergillosis (IAPA) criteria-Verweij et al.; ICU, intensive care unit; LRTC, lower respiratory tract cultures; NR, non recorded/negative; ODI, optimal density index; PCR, polymerase chain reaction; Spp., species.