The aim of this project is therefore to explore on the clinical significance of analyzing surrogate markers combined with conventional diagnostics in the ICU setting. BAL, blood and biopsy samples will be subjected to a combined analysis of GM, BDG, Aspergillus specific PCR assays in addition to conventional diagnostics (Microscopy, Culture,Histology) for ICU pts with pulmonary infiltrates.

As GM and BDG are not species-specific, three established and repeatedly published species specific PCR-based assays (nested PCR, real time PCR assay, multifungal DNA Array)developed by our group will be investigated in combination with the serological tests in a multicenter prospective clinical diagnostic trial.

Inclusion Criteria:

• underlying conditions (see above)
• being on mechanical ventilation
• lung infiltrates

Exclusion Criteria:

• immunocompetent patients (not fulfilling the criteria above)

Immunocompromised patients on the intensive care unit with lun infiltrates and one of the following underlying conditions:

• Underlying malignancy
• Antineoplastic chemotherapy
• Neutropenia
• Allogeneic hematopoietic stem cell transplantation
• Solid organ transplantation
• Retransplantation
• Acute or chronic immunological rejection or graft-versus-host-disease
• Treatment with immunosuppressive agents (calcineurin inhibitors, OKT3, etc)
• Profound systemic corticosteroid therapy prior to ICU admission
• COPD Gold III/IV
• Advanced liver cirrhosis and ICU treatment for more than 7 days
• Hemodialysis, renal failure
• CMV infection
• HIV infection; CD4 cellcount
• Post splenectomy
• Post cardiac surgery
• Diabetes mellitus
• mechanical ventilation for more than 21 days
• ICU-based steroid therapy and corticosteroid treatment for more than 7 days
• Malnutrition
• Severe burn wounds