Table 2.
Criteria for proven and probable invasive fungal disease, excluding endemic mycosesa
| Proven IFD |
Mold • Histopathological, cytopathological or microscopic examination of a sterile specimen in which hyphae are seen with associated tissue damage • Recovery of a mold or “black yeast” by culture of a sterile specimen • Blood culture that yields a mold (e.g., Fusarium spp.)c Yeast • Histopathological, cytopathological or microscopic examination of a sterile specimen showing yeast cells • Recovery of a yeast by culture of a sterile specimen obtained from a site with clinical or radiographic findings consistent with an infectious disease • Blood culture that yields yeast or a yeast-like fungi (e.g. Candida spp., Cryptococcus spp., or Trichosporon spp.) • Presence of cryptococcal antigen in the CSF |
| Probable or Possible IFDb | • Presence of host factorsd • Prolonged, profound neutropenia • Receipt of an allogeneic HSCT • Prolonged use of corticosteroids • Treatment with T-cell immunosuppressants • Presence of a severe inherited immunodeficiency • Presence of clinical criteria consistent with IFD • Radiographic findings of lower respiratory tract fungal disease • Evidence of tracheobronchitis on bronchoscopy • Radiographic evidence of sinonasal disease • Signs of CNS infection on imaging • Evidence of disseminated candidiasis on imaging or examination • Mycological evidence of infection • Presence of mold in sputum, bronchoalveolar lavage fluid, or sinus aspirate sample, either through histopathological analysis or culture • Positive indirect testing for IFD, including positive galactomannan antigen testing for aspergillosis or beta-D-glucan detected in the serum for other IFD |
a
Adapted from De Pauw, et al 2008
b
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.
c
Blood cultures are rarely positive for molds other than Fusarium spp.
d
Characteristics by which individuals predisposed to invasive fungal diseases can be recognized