Diagnosis of invasive bronchial-pulmonary aspergillosis in patients with chronic obstructive respiratory diseases

the article by He and colleagues [1] on invasive bronchialpulmonary aspergillosis (IBPA) in critically ill patients with chronic obstructive respiratory diseases (CORDs). In this prospective study, the authors, contrary to their statement, did not follow the case defi nitions for ‘probable’ invasive pulmonary aspergillosis (IPA) as defi ned by the consensus of the European Organization for Research and Treatment of Cancer and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) [2]. Indeed, EORTC/MSG criteria for probable IPA require that all three of the following concomitant conditions be fulfi lled: presence of a host factor, presence of a clinical criterion, and presence of a mycological criterion. In the study group with IBPA, at least two patients (patients 4 and 13) did not fulfi ll these criteria and thus were erroneously incorporated in the case group. Furthermore, only 4 patients (out of 13) had histologically proven invasive bronchial aspergillosis, and many patients thus may have been erroneously classifi ed in the IBPA group since no autopsy was performed. Considering the low number of patients with IBPA as well as the misclassifi cation of some of them, we feel that providing independent variables predicting IBPA (with further extrapolation of a diagnostic algorithm) in critically ill patients with CORD is irrelevant.