Table 2. Criteria for probable invasive fungal disease except for endemic mycoses.
| Host factorsa |
| Recent history of neutropenia (<0.5 × 109 neutrophils/L [<500 neutrophils/mm3] for >10 days) temporally related to the onset of fungal disease |
| Receipt of an allogeneic stem cell transplant |
| Prolonged use of corticosteroids (excluding among patients with allergic bronchopulmonary aspergillosis) at a mean minimum dose of 0.3 mg/kg/day of prednisone equivalent for >3 weeks |
| Treatment with other recognized T cell immunosuppressants, such as cyclosporine, TNF-α blockers, specific monoclonal antibodies (such as alemtuzumab), or nucleoside analogues during the past 90 days |
| Inherited severe immunodeficiency (such as chronic granulomatous disease or severe combined immunodeficiency) |
| Clinical criteriab |
| Lower respiratory tract fungal diseasec |
| The presence of 1 of the following 3 signs on CT: |
| Dense, well-circumscribed lesions(s) with or without a halo sign |
| Air-crescent sign |
| Cavity |
| Tracheobronchitis |
| Tracheobronchial ulceration, nodule, pseudomembrane, plaque, or eschar seen on bronchoscopic analysis |
| Sinonasal infection |
| Imaging showing sinusitis plus at least 1 of the following 3 signs: |
| Acute localized pain (including pain radiating to the eye) |
| Nasal ulcer with black eschar |
| Extension from the paranasal sinus across bony barriers, including into the orbit |
| CNS infection |
| 1 of the following 2 signs: |
| Focal lesions on imaging |
| Meningeal enhancement on MRI or CT |
| Disseminated candidiasisd |
| At least 1 of the following 2 entities after an episode of candidemia within the previous 2 weeks: |
| Small, target-like abscesses (bull's-eye lesions) in liver or spleen |
| Progressive retinal exudates on ophthalmologic examination |
| Mycological criteria |
| Direct test (cytology, direct microscopy, or culture) |
| Mold in sputum, bronchoalveolar lavage fluid, bronchial brush, or sinus aspirate samples, indicated by 1 of the following: |
| Presence of fungal elements indicating a mold |
| Recovery by culture of a mold (e.g., Aspergillus, Fusarium, Zygomycetes, or Scedosporium species) |
| Indirect tests (detection of antigen or cell-wall constituents)e |
| Aspergillosis |
| Galactomannan antigen detected in plasma, serum, bronchoalveolar lavage fluid, or CSF |
| Invasive fungal disease other than cryptococcosis and zygomycoses |
| β-d-glucan detected in serum |
NOTE. Probable IFD requires the presence of a host factor, a clinical criterion, and a mycological criterion. Cases that meet the criteria for a host factor and a clinical criterion but for which mycological criteria are absent are considered possible IFD.
Host factors are not synonymous with risk factors and are characteristics by which individuals predisposed to invasive fungal diseases can be recognized. They are intended primarily to apply to patients given treatment for malignant disease and to recipients of allogeneic hematopoietic stem cell and solid-organ transplants. These host factors are also applicable to patients who receive corticosteroids and other T cell suppressants as well as to patients with primary immunodeficiencies.
Must be consistent with the mycological findings, if any, and must be temporally related to current episode.
Every reasonable attempt should be made to exclude an alternative etiology.
The presence of signs and symptoms consistent with sepsis syndrome indicates acute disseminated disease, whereas their absence denotes chronic disseminated disease.
e These tests are primarily applicable to aspergillosis and candidiasis and are not useful in diagnosing infections due to Cryptococcus species or Zygomycetes (e.g., Rhizopus, Mucor, or Absidia species). Detection of nucleic acid is not included, because there are as yet no validated or standardized methods.