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Volume 24, Number 8—August 2018
Online Report

Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings

David W. DenningComments to Author , Iain D. Page, Jeremiah Chakaya, Kauser Jabeen, Cecilia M. Jude, Muriel Cornet, Ana Alastruey-Izquierdo, Felix Bongomin, Paul Bowyer, Arunaloke Chakrabarti, Sara Gago, John Guto, Bruno Hochhegger, Martin Hoenigl, Muhammad Irfan, Nicholas Irurhe, Koichi Izumikawa, Bruce Kirenga, Veronica Manduku, Samihah Moazam, Rita O. Oladele, Malcolm D. Richardson, Juan Luis Rodriguez Tudela, Anna Rozaliyani, Helmut J.F. Salzer, Richard Sawyer, Nasilele F. Simukulwa, Alena Skrahina, Charlotte Sriruttan, Findra Setianingrum, Bayu A.P. Wilopo, Donald C. Cole, and Haileyesus Getahun
Author affiliations: University of Manchester, Manchester, UK (D.W. Denning, I.D. Page, F. Bongomin, P. Bowyer, S. Gago, R.O. Oladele, C. Sriruttan, F. Setianingrum, B.A.P. Wilopo); Wythenshawe Hospital Manchester University NHS Foundation Trust, Manchester (D.W. Denning, I.D. Page, S. Moazam, M.D. Richardson, R. Sawyer); The Global Action Fund for Fungal Infections, Geneva, Switzerland (D.W. Denning, J. Guto, J.L. Rodriguez Tudela); Kenya Medical Research Institute, Nairobi, Kenya (J. Chakaya, V. Manduku); Aga Khan University, Karachi, Pakistan (K. Jabeen, M. Irfan); Olive View–UCLA Medical Center, Sylmar, California, USA (C.M. Jude); Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France (M. Cornet); Instituto de Salud Carlos III, Madrid, Spain (A. Alastruey-Izquierdo); Postgraduate Institute of Medical Education and Research, Chandigarh, India (A. Chakrabarti); Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil (B. Hochhegger); University of California San Diego, San Diego, California, USA (M. Hoenigl); Medical University of Graz, Graz, Austria (M. Hoenigl); Center for Biomarker Research in Medicine, Graz (M. Hoenigl); Lagos University Teaching Hospital, Lagos, Nigeria (N. Irurhe); Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (K. Izumikawa); Mulago Hospital and Makerere University, Kampala, Uganda (B. Kirenga); University of Lagos, Lagos (R.O. Oladele); Universitas Indonesia, Jakarta, Indonesia (A. Rozaliyani, F. Setianingrum); Research Center Borstel, Borstel, Germany (H.J.F. Salzer); Royal Liverpool University Hospital, Liverpool, UK (N.F. Simukulwa); The Republican Scientific and Practical Centre for Pulmonology and TB, Minsk, Belarus (A. Skrahina, C. Sriruttan); National Institute for Communicable Diseases, Johannesburg, South Africa (C. Sriruttan); University of the Witwatersrand, Johannesburg (C. Sriruttan); Universitas Padjadjaran, Bandung, Indonesia (B.A.P. Wilopo); University of Toronto, Toronto, Ontario, Canada (D.C. Cole); World Health Organization, Geneva (H. Getahun)

Main Article

Table 3

Final consensus definition of CPA in resource-constrained settings, determined by Global Action Fund for Fungal Infections international expert panel*

Required criteria† Details
Symptoms for >3 mo Hemoptysis and/or persistent cough and/or weight loss; Other symptoms are common, but not requred, notably fatigue, chest pain, dyspnea, and sputum production
Radiologic features Progressive cavitation on chest imaging and/or intracavitary fungal ball and/or pleural thickening or pericavitary fibrosis or infiltrates all adjacent to cavities
Microbiological evidence of Aspergillus infection Positive Aspergillus-specific IgG and/or sputum microscopy results showing hyphae consistent with Aspergillus and/or Aspergillus growth on >2 sputum or other respiratory samples
Mycobacterial infection ruled out with smear, GeneXpert, and/or mycobacterial culture‡ It is possible for mycobacterial infection and CPA to be present concurrently, but this diagnosis requires characteristic radiological findings on CT scan that are not present with pulmonary TB including pleural thickening, a fungal ball or other intracavitary material, or marked pericavitary infiltrates in addition to a positive Aspergillus IgG antibody test

*CPA, chronic pulmonary aspergillosis; CT, computed tomography; TB, tuberculosis.
†All 4 criteria are required.
‡GeneXpert (

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Page created: July 17, 2018
Page updated: July 17, 2018
Page reviewed: July 17, 2018
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