Table 1.

Criteria for Diagnosis of IFD in the Elderly Patients

Category	Criteria
Proven	Histopathological examination reveals fungal infection in normally sterile sites, or recovery of a mold/yeast from samples obtained by a sterile procedure, or blood culture yielding a mold/yeast (Aspergillus spp. excluded)
Probable	Elderly patients satisfying the following clinical and mycological criteria were considered to have probable mold infection.
Mold infection	a. Clinical criteria
	Lung infection: pulmonary CT scan showed i) dense, well-circumscribed lesions with or without a halo sign, or ii) air-crescent sign, or iii) cavity; or bronchoscopy found tracheobronchial ulceration, nodule, pseudomembrane, plaque, or eschar.
	Sinonasal infection: imaging suggesting sinusitis with i) acute localized pain, and/or ii) evidence of bone erosion, and/or iii) nasal ulcer with black eschar revealed by nasal endoscopy
	CNS infection: imaging showing focal lesions or meningeal enhancement
	b. Mycological criteria: satisfying at least one of the following criteria
	i) Mold in sputum, BALF, bronchial brush, or sinus aspirate samples
	ii) Positive GM antigen detection in plasma, serum, BALF or CSF (for aspergillosis only).
Cryptococcosis	Elderly patients showing one of the aforementioned radiographic manifestation along with i) Cryptococcus spp. isolated in sputum, BALF, bronchial brush; or ii) positive CrAg detection in serum or CSF.
Possible
Mold infection/Cryptococcosis	Elderly patients satisfying the aforementioned clinical criteria but without mycological evidence were considered to have possible mold infection/cryptococcosis.
Yeast infection	a. Lung infection: elderly patients satisfying all the following criteria were considered to have possible pulmonary candidiasis: i) clinical symptoms suggesting lung infection and CT scan showing new onset bronchopneumonia or micronodules or diffused infiltrates, ii) positive twice in microscopic examination showing fungal hyphae/pseudohyphae and recovery twice of the same yeast in sputum/BALF culture, iii) positive twice in serum G-test, iv) excluded other possible pathogens
	b. UTI: elderly patients satisfying all the following criteria were considered to have possible urinary candidiasis: i) clinical symptoms indicating urinary infection, ii) increased leukocytes in clean catch midstream urine, iii) positive twice in urine culture for the same yeast, iv) excluded other possible pathogens
	c. Esophageal infection: elderly patients satisfying all the following criteria were considered to have possible esophageal candidiasis: i) white plaques found in endoscopic examination, ii) fungal hyphae, pseudohyphae or spores found in esophageal brushing sample

Abbreviations: BALF, bronchoalveolar lavage fluid; CNS, central nervous system; CrAg, cryptococcal capsule polyglycan antigen; CSF, cerebrospinal fluid; CT, computed tomography; G-test, β-D-glucan detection; GM, galactomannan; IFD, invasive fungal disease; UTI, urinary tract infection.