Which algorithm diagnoses invasive pulmonary aspergillosis best in ICU patients with COPD?

Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection, mainly affecting immunocompromised patients, particularly those with prolonged neutropenia [1]. Several reports have shown that Aspergillus spp. can also cause IPA in patients with a priori less severe immune dysfunction, such as those in intensive care units (ICUs) [2–5] or with chronic obstructive pulmonary disease (COPD) [5–8]. In these patients, diagnosis of IPA remains a challenge, because the reference diagnostic criteria (defined by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG)) were developed for research in high-risk patients and not specifically for patients in the ICU or patients with COPD [9]. Two alternative algorithms have been proposed for this setting: the COPD algorithm for patients with COPD [6] and the Clinical algorithm for patients in the ICU [10]. In ICU COPD patients, the Clinical algorithm seems to be more useful to diagnose IPA than the COPD or EORTC/MSG ones The AspICU Study Investigators are as follows: Miguel Blasco-Navalpotro, Hospital Universitario Severo Ochoa (Madrid, Spain); Stijn Blot, Ghent University (Ghent, Belgium); Nele Brusselaers, Ghent University Hospital, (Ghent, Belgium); Pierre Bulpa, Mont-Godinne University Hospital (Yvoir, Belgium); Teresa Cardoso, Hospital de Santo Antonio (Porto, Portugal); Pierre-Emmanuel Charles, Dijon University Hospital (Dijon, France); Didier Clause, Cliniques de l'Europe (Brussels, Belgium); Patricia Courouble, Cliniques Universitaires Saint Luc (Brussels, Belgium); Emmanuel De Laere, Heilig Hartziekenhuis Roeselaere-Menen (Roeselaere, Belgium); George Dimopoulos, University Hospital Attikon (Athens, Greece); Frédéric Forêt, Centre Hospitalier Régional Mons-Warquignies (Mons, Belgium); Dan Li, Shangai Public Health Clinical Center (Shangai, China); Claude Martin, Assistance publique hôpitaux de Marseille, (Marseille, France); Shahram Mashayekhi, Centre Hospitalier Grand Hornu (Hornu, Belgium); Wouter Meersseman, Universitair Ziekenhuis Gasthuisberg (Leuven, Belgium); Benoit Misset, Hôpital Saint-Joseph (Paris, France); José Artur Paiva, Hospital de Sao Joao, (Porto, Portugal); Paulo Mergulhao, Hospital de Sao Joao (Porto, Portugal); Alessandro Pasqualotto, Santa Casa-Complexo Hospitalar (Porto Allegre, Brazil); Marcos Pérez, Vall d'Hebron University Hospital (Barcelona, Spain); Ratna Rao, Apollo Hospital (Hyderabad, India); Jordi Rello, Joan XXIII University Hospital (Tarragona, Spain) and Vall d'Hebron University Hospital (Barcelona, Spain); Jessica Souto, Vall d'Hebron University Hospital (Barcelona, Spain); Herbert Spapen, Brussels University Hospital (Brussels, Belgium); Fabio Silvio Taccone, Hôpital Erasme (Brussels, Belgium); Anne-Marie Van den Abeele, AZ Sint Lucas, (Ghent, Belgium); Koenraad Vandewoude, Ghent University Hospital, (Ghent, Belgium); and Dirk Vogelaers, Ghent University Hospital (Ghent, Belgium).