Determinations:
(1) confidence in diagnosis: proven vs probable vs possible vs not diagnosed
(2) organism: mold vs Candida species vs Cryptococcus vs dimorphic yeast
(3) syndrome: pulmonary vs sinonasal vs CNS vs fungemia vs disseminated
Proven deep tissue infection with mold - one or both of the following:
(1) microscopic examination demonstrating fungal form AND microscopic or imaging evidence of tissue injury
(2) positive culture from normally sterile site (not urine or mucuous membrane) AND clinical and/or radiologic findings consistent with infection
Proven deep tissue infection with yeast - one or more of the following:
(1) microscopic examination demonstrating fungal form AND microscopic or imaging evidence of tissue injury
(2) positive culture from normally sterile site (not urine, sinus or mucuous membrane) AND clinical and/or radiologic findings consistent with infection
(3) antigen for Cryptococcus in CSF AND clinical and/or radiologic findings consistent with infection AND no evidence of a false positive antigen test
Proven fungemia with mold – both of the following:
(1) positive blood culture
(2) compatible signs and symptoms
Proven fungemia with yeast – both of the following:
(1) positive blood culture
(2) compatible signs and symptoms
Proven pulmonary dimorphic (endemic) fungus - one or both of the following:
(1) positive culture from sputum, BAL or lung biopsy AND comparable signs and symptoms
(2) microscopic identification in specimen
Proven extrapulmonary dimorphic (endemic) fungus extrapulmonary - one or both of the following:
(1) positive culture from site affected AND comparable signs and symptoms
(2) microscopic identification in specimen
Proven disseminated dimorphic (endemic) fungus - one or both of the following:
(1) positive blood culture
(2) antigen demonstrated in serum or urine
Probable invasive fungal infections – not proven and all of the following:
(1) >= 1 host factor
(2) >= 1 microbiological criterion
(3) one of the following:
(3a) >= 1 major clinical criterion
(3b) >= 2 minor clinical criterion
Probable disseminated candidiasis – not proven and all of the following:
(1) >= 1 host factor
(2) characteristic lesions
Probable candidemia – not proven and all of the following:
(1) >= 1 host factor
(2) >= 1 microbiological criterion indicating Candidemia
Possible invasive fungal infection – not probable and all of the following:
(1) >= 1 host factor
(2) one of the following:
(2a) >= 1 microbiological criterion
(2b) >= 1 major clinical criterion
(2c) >= 2 minor clinical criterion
where:
• The clinical criteria are for lower respiratory tract, sinonasal, CNS or disseminated infections.
