Is Bulpa criteria suitable for the diagnosis of probable invasive pulmonary Aspergillosis in critically ill patients with chronic obstructive pulmonary disease? A comparative study with EORTC/ MSG and ICU criteria
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Three diagnostic criteria have been proposed used for invasive pulmonary aspergillosis (IPA) diagnosis, namely EORTC/ MSG criteria, Bulpa criteria and intensive care unit (ICU) criteria. The Bulpa criteria were proposed to diagnose IPA in chronic obstructive pulmonary disease (COPD) patients specially. Our aim is to verify that whether the Bulpa criteria are the most suitable for diagnosing probable IPA in critically ill COPD patients compared with the other two criteria. We included critically ill COPD patients admitted to the ICU from April 2006 to August 2013. Patients were classified into four populations: population one (n 1 = 59) comprised all included patients; population two (n 2 = 24) comprised patients with positive mycological findings (both positive cultures and positive serologic tests); population three (n 3 = 18) comprised patients with positive lower respiratory tracts (LRTs) isolation; and population four (n 4 = 5) comprised proven IPA patients with histopathology. Patients in four groups were diagnosed as probable IPA using three criteria respectively, and the “diagnostic rate” of each criteria were compared with each other. Then, the reasons for differences in “diagnostic rate” were analyzed in population two. Finally, the modified Bulpa criteria were proposed. Bulpa criteria yielded the highest “diagnostic rate” of probable IPA followed by the ICU criteria, while the EORTC/ MSG criteria provided the lowest rates in four populations (the “diagnostic rate” of probable IPA was 33.9%, 16.9% and 6.8% in population one, p = 0.001; 83.3%, 41.7% and 16.7% in population two, p < 0.001; 100%, 55.6% and 22.2% in population three, p < 0.001; 100%, 60% and 20% in population four, p = 0.036). The reasons for the highest “diagnostic rate” by Bulpa criteria were its less strict requirements regarding the doses/courses of steroid use and typical computed tomography (CT) findings. Finally, the modified Bulpa criteria for probable IPA were proposed for critically ill COPD patients admitted to ICU, mainly involving revised interpretations of microbiological findings. Among the existing three criteria, the Bulpa criteria are the most suitable for diagnosing probable IPA in critically ill COPD patients admitted to ICU. A modified criteria maybe proposed for better diagnosis,and its clinical validity need to be verified in future studies.
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A large proportion of IPA cases still are not detected by existing criteria, especially in nonneutropenic patients who possess atypical clinical and radiographic features of infection.
“However, a large proportion of IPA cases still are not detected by existing criteria, especially in nonneutropenic patients who possess atypical clinical and radiographic features of infection (95–97).”
From Aspergillus fumigatus and Aspergillosis in 2019 (2019) · cites this paper as [97]
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- Authors
- Huang, L., He, H., Jin, J., & Zhan, Q.
- Affiliations
- China-Japan Friendship Hospital (CN)
- Capital Medical University (CN)
- Corresponding author
- Zhan, Qingyuan
- Venue
- BMC Infectious Diseases
- Published
- 2017-03-14
- Volume
- 17
- Issue
- 1
- Pages
- 209-209
- ISSN
- 1471-2334 (ISSN-L)
- PMC
- PMC5351185
- OpenAlex
- W2596189086
- Cited by
- 25
- References
- 33
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 5 · 2018: 6
- FWCI
- 2.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Infectious Diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Beijing Municipal Administration of Hospitals’ Youth Programme (QML 20150301)
- National Key Research and Development Programme—Major Chronic Non-communicable Diseases’ Prevention and Control (QML 2016YFC1304300)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- invasive pulmonary aspergillosis, EORTC/MSG criteria, diagnostic criteria, chronic obstructive pulmonary disease, critically ill patients, diagnostic rate, corticosteroid use, computed tomography findings, serologic tests, histopathology, immunosuppression
- MeSH terms
- Female, Humans, Intensive Care Units, Male, Middle Aged, Opportunistic Infections, Prognosis, Critical Illness, Pulmonary Disease, Chronic Obstructive, Invasive Pulmonary Aspergillosis
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