Aspergillosis diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]; Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Diagnostic criteria are available for allergic bronchopulmonary aspergillosis and for allergic fungal rhinosinusitis. Major and minor diagnostic criteria are based on clinical, laboratory, and radiological findings.

Diagnostic Criteria

Allergic Bronchopulmonary Aspergillosis

The following table shows the diagnostic criteria for allergic bronchopulmonary aspergillosis:

Major	Minor
Asthma	Presence of Aspergillus in sputum
Roentgenographic fleeting pulmonary opacities	Expectoration of brownish black mucus plugs
Skin test positive for Aspergillus	Delayed skin reaction to Aspergillus antigen
Eosinophilia
IgE in serum elevated (> 500 IU/mL)- revised 2024 criteria
Central bronchiectasis
Serums A fumigatus-specific IgG and IgE
Precipitating antibodies (IgG) in serum

Allergic Fungal Rhinosinusitis

The following table shows the 1994 Bent and Kuhn diagnostic criteria for allergic fungal rhinosinusitis:

Major	Minor
Type I hypersensitivity	Asthma
Nasal polyposis	Unilateral disease
Characteristic CT findings (see here)	Bone erosion
Eosinophilic mucin without invasion	Fungal cultures
Positive fungal stain	Charcot-Leyden crystals
	Serum eosinophilia

^{Table adapted from Bent JP 3rd, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg.1994 111(5):580-8}

• To make the diagnosis of allergic fungal rhinosinusitis, patients must meet ALL the major criteria.
• Minor criteria may support the diagnosis, but they are not considered diagnostic.