Table 1 Fungal Infectious Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria for IA [12] (The items which met the current case before LT are described in bold)
Proven IA |
Microscopic analysis on sterile material: a specimen obtained by needle aspiration or sterile biopsy in which hyphae are seen accompanied by evidence of tissue damage or culture on sterile material for Aspergillus becomes positive |
Probable IA (requires at least one item for each factor, but mycological criteria are absent for proven IA criteria) |
[Host factors] |
Recent history of neutropenia (< 500 neutrophils/mm3 for > 10 days) |
Recipient of an allogeneic stem cell transplant |
Prolonged use of corticosteroids at a dose of 0.3 mg/kg/day of prednisone equivalent for > 3 weeks |
Treatment with other recognized T cell immunosuppressants during the past 90 days (such as TNF-α blockers, specific monoclonal antibody, or nucleoside analogues) |
Inherited severe immunodeficiency (such as chronic granulomatous disease or severe combined immunodeficiency) |
[Clinical criteria] |
Lower respiratory tract fungal disease |
The presence of one of the following three signs on CT |
Dense, well-circumscribed lesion(s) with or without a halo sign Air-crescent sign Cavity |
[Mycological criteria] |
Mold in sputum, BAL, fluid, bronchial brush, indicated by 1 of the following |
Presence of fungal elements indicating a mold |
Recovery of Aspergillus by culture or indirect tests (detection of antigen or cell wall constituents) |
Galactomannan antigen detected in serum or BAL fluid |
β-d Glucan detected in serum |