Table 1.

Definition of CAPA.

Definition	Clinical	Radiological	Mycological
COVID-19-associated pulmonary aspergillosis White [5]	PCR confirmed COVID-19 infection and one of: refractory fever despite at least 3 days antibiotics. Recrudescent fever of at least 48 h despite antibiotics. Dyspnea, hemoptysis, and pleural rub or chest pain. Worsening respiratory function despite antibiotics and ventilatory support.	New infiltrates on chest X-ray or chest CT when compared with admission, including progression of signs attributed to viral infection. Radiological signs typical of invasive pulmonary aspergillosis (nodules, halos, cavities, wedgeshaped and segmental or lobar consolidation) or evidence of sinusitis should be associated with heightened suspicion of fungal disease.	Proven: Histology/microscopy demonstrating dichotomous septate hyphae in tissue; positive culture from tissue. Putative: Nonspecific radiology: two or more positives across different test types, or multiple positives within one test type, from the following: positive culture from NBL/BAL-positive GM-EIA in NBL/BAL (I ≥ 1.0), positive GM-EIA in serum (I ≥ 0.5), positive Aspergillus PCR in NBL BAL or blood; and positive 1-3-β-D glucan in serum/plasma. Radiology typical of IA: one positive mycological test as listed, unless the typical radiological signs can be attributed to a different underlying infection (e.g., lung cancer, alternative infection). In this scenario multiple positive results would be required to attain a diagnosis of putative IPA. Note: given the etiological diversity associated with sinusitis, multiple positive tests from this list are required to attain a diagnosis of putative IPA.
Modified AspICU eDutch/Belgian Mycosis Study Group [6]	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.
CAPA-European Excellence Centre for Medical Mycology [3]	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.
EORTC/MSGERC [7]	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, wellcircumscribed 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).