Pati ent wit h un derlying diseases
1 ,2
has 2 or more
im agi ng tes t resul ts with one of the following:
New & persistent OR
Progressive & persistent
Inf iltrate
Consolidation
Cavitation
Pneumatoceles, in ≤ 1 y.o
PNU1 / PNU2
At least one of the following:
Fever (> 38.0°C or > 100.4°F)
Le uko pe nia (≤ 4,00 0 WBC/mm
3
) or leukocytos is (≥ 12,000 WBC/mm
3
)
Al tered ment al stat us with no othe r cause, i n ≥ 70 y. o.
PNU1
And at le ast two of the following (from
separate bullets):
New onset of purulent
sputum
3
, or change i n character
of sputum
4
, or increa sed
respiratory secretions, or
in cre ased suc ti oni ng
require me nts
Dyspnea, or tachypnea
5
, or new
onset or worsening cough
Rales
6
or bronc hial brea th
sounds
Worsening ga s exchange (for
exampl e, O
2
desaturations [f or
exampl e, PaO
2
/FiO
2
≤ 240]
7
,
increased oxygen
require ment s, or increas ed
ventilator de man d)
PNU2
And at le ast one
of the following:
New onset of purulent sputum
3
,
or change i n character of
sputum
4
, or increa sed
respiratory secretions, or
increased suctioning
require me nts
Dyspnea, or tachypnea
5
, or new
onset or worsening cough
Rales
6
or bronc hial brea th
sounds
Worsening ga s exc hange (for
exampl e, O
2
desaturations [f or
exampl e, PaO
2
/FiO
2
< 240]
7
,
increased oxygenation
require me nts, or increas ed
ventilator de man d)
PNU3
At least o ne of the following:
Identification of matching Candida
spp. from blood and one of the
following: sputum, endotracheal
aspirate, BAL or protected specimen
brushing
1 1, 12, 13
Evidence of fungi (e xc luding any
Can dida spp. a nd yeas t not
otherwise specifi ed) from mini mal ly
contaminated LRT specimen
(specif ically BAL, protected s pecimen
brushing or endotracheal aspirate)
fr om o ne
of the following:
• Direc t micros copi c exam
• Positive culture of fungi
• Non
-culture diagnostic
la boratory te st
PNU2 / PNU3
At least one of the following:
Virus, Borde tel la, Legio nella,
Chl amydia, or Mycopl asm a identified
from respiratory secretions or tissue
by a culture or non-culture based
microbiologic testing method which
is performed for purposes of clinical
diagnos is or t reatment (f or e xampl e,
not Active Surveillance Culture/
Testing (ASC/AST))
4-fold rise in paired sera (IgG) for
patho gen (for ex ampl e, i nfl uenza
viruses, Chlamyd ia)
4-fold rise in Le gione lla p neu moph ila
an tibod y tite r to ≥ 1:128 in paired
acute and convale sce nt se ra by
indirect IFA
Detection of Le gionella p neu moph ila
serogroup 1 antigens in urine by RIA
or EIA
PNU3
PNU2
PNU1
PNU2 / PNU3
At least one of the following:
Organism identified from blood
8,13
Organism identified from pleural
fluid
9,13
Positive quantitative culture or
corresponding semi-quantitati ve
result
9
fr om minimal ly-contaminated
LRT specimen (specifically, BAL,
protected specimen brushing, or
endotracheal aspirate)
≥ 5% BAL-obtained c ells contain
intracellular bacteria on direct
microscopic exam
Positive quantitative culture or
corresponding semi-quantitati ve
result
9
of l ung tis sue
Histopathologic exam shows at least
one of the following:
• Abscess formation or foci of
consolidation with intense
PMN accumulation in
bronchioles and alveoli
• Evidence of lung
pare nchyma invasion by
fungal hyphae or
pseudohyphae
LABORATORY
SIGNS & SYMPTOMS IMAGING
PNU3
At least o ne of the following in an immunocompromised
pat ie nt
10 :
Fever ( > 38.0°C or > 100.4°F)
Al ter ed mental stat us w it h no o the r cau se, in ≥ 70 y. o.
New onset of purulent sputum
3
, or change i n character of
sputum
4
, or increased respiratory secretions, or increased
suctioning requirements
Dyspnea, or tachypnea
5
, or ne w onset or worse ning coug h
Rales
6
or bronc hial brea th so und s
Worsening ga s exchange (for example, O
2
desaturations
[for example, PaO
2
/FiO
2
≤ 240]
7
, increased oxygen
require me nts, or increas ed ventilator dem and)
Hemop tysi s
Pleuritic ches t pain
Pati ent without underlying diseases
1 ,2
has 1 or more
imaging tes t results with one of the following:
New & persistent OR
Progressive & persistent
Inf iltrate
Consolidation
Cavitation
Pneumatoceles, in ≤ 1 y.o.
OR
PNU 1
PNU 2
PNU 3