The Invasive Fungal Infection Cooperative Group (IFICG) of the European Organization for Research and Treatment of Cancer (EORTC) and the Mycoses Study Group of the National Institute of Allergy and Infectious Diseases (NIAID) have defined diagnostic categories associated with invasive opportunistic fungal infections in a patient with cancer or an hematopoietic stem cell transplant.
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.
Specialty: Infectious Diseases, Surgery, general