Volume 24, Number 8—August 2018
Online Report
Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings
Table 1
Parameter |
Reference |
|||||
(21) |
(22) |
(23) |
(24)† |
(25) |
(26) |
|
Symptoms |
>1 of the following for 3 mo: WL, productive cough, hemoptysis plus absence of overt immunosuppression |
>1 of the following (no duration specified): fever, WL, sputum production, cough, hemoptysis, fatigue, shortness of breath |
Performance status 1–2 |
All of the following required for 1–6 mo: fever, cough, sputum production, weight loss |
>1 of the following for 3 mo: weight loss, productive cough, hemoptysis plus absence of overt immunosuppression |
“Significant pulmonary and/or systemic symptoms for 3 months or more”; no specific symptoms listed |
Radiology |
>1 of the following: cavitary lesion with paracavitary fibrosis, new or expanding cavity on serial imaging |
>1 of the following: new infiltrates, cavity formation, expansion of preexisting cavities; with or without the following: pericavitary infiltrates, adjacent pleural thickening |
Compatible chest CT scan or photo-graphically confirmed endoscopic lesion |
Cavitary pulmonary lesion with evidence of pericavitary infiltrates and adjacent pleural thickening with/without fungal ball |
>1 of the following: cavitary lesion with paracavitary fibrosis, new or expanding cavity on serial imaging |
Both required: >1 pulmonary cavities with either thick or thin wall, possibly containing aspergilloma or irregular intraluminal material; overt radiologic progression over >3 mo required (new cavities, increasing pericavitary infiltrates, or increasing fibrosis) |
Aspergillus antibody/ culture |
Either positive precipitins, or, culture from pulmonary or pleural cavity |
>1 of the following: platelia serum galactomannan index >1.0, positive precipitins, positive (1,3)-β-D-glucan, evidence of Aspergillus spp. by molecular diagnosis, culture or pathological findings |
Positive serologic test required by both of the following: precipitins by CIE with >2 lines, second serologic test positive by any method; and microbiological evidence by 1 of the following sources from BAL or sputum samples: >2 or more positive cultures, 1 positive culture and positive microscopy |
Culture from sputum or BAL mandatory, antibodies not required |
Either raised Aspergillus-specific IgG or culture from pulmonary or
pleural cavity |
If fungal ball present: Aspergillus-IgG/precipitins or other evidence of Aspergillus. If no fungal ball but >1 cavities, then any of the following: Aspergillus-specific IgG, Aspergillus precipitins, strongly positive Aspergillus antigen or DNA in respiratory fluids, percutaneous or excision biopsy showing fungal hyphae on microscopy, growing Aspergillus from a cavity. These tests on respiratory samples not sufficient in isolation: culture, PCR, microscopy |
Inflammatory markers |
Raised levels of either: CRP, ESR, plasma viscosity |
>1 of the following raised: leukocyte count, CRP, ESR |
Not required |
Not required |
Raised levels of either: CRP, ESR |
Not required |
Exclusion of other pathogens | Required with the following examples: mycobacteria, endemic mycoses | Lack of improvement with >3 d of broad-spectrum antimicrobial drugs required; patients with infectious diseases other than aspergillosis excluded | Not required | Required with the following examples: TB, other mycoses, granulomatosis with polyangiitis, ABPA, invasive aspergillosis, simple aspergilloma† | Not specifically required | Required with the following examples: TB, atypical mycobacteria, necrotizing lung cancer, pulmonary infarction, vasculitides, rheumatoid nodule, histoplasmosis/ coccidioidomycosis/ paracoccidioido-mycosis in those with relevant travel history |
*ABPA, allergic bronchopulmonary aspergillosis; BAL, bronchoalveolar lavage; CIE, counterimmunoelectrophoresis; CNPA, chronic necrotizing pulmonary aspergillosis; CRP, C-reactive protein: CT, computed tomography; ESR, erythrocyte sedimentation rate; TB, tuberculosis; WL, weight loss.
†This definition includes CNPA cases with 1–3 mo symptoms. Note: precipitins sensitivity even lower than culture. Pleural thickening seems to be a mandatory criterion.
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