EORTC/MSG criteria for invasive fungal disease

Criteria for possible and probable invasive fungal disease except for endemic mycoses

Probable IFD requires: the presence of a host factor, a clinical criterion, and a mycological criterion.

Possible IFD is established when cases meet the criteria for a host factor and a clinical criterion but a mycological criteria lacks.

Host factors

  • Recent history of neutropenia (<0.5 x 10e9 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, TNFblockers, 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 criteria

(must be consistent with the mycological findings, if any, and must be temporally related to current episode)

  • Lower respiratory tract fungal disease (every reasonable attempt should be made to exclude an alternative etiology)
    • 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 escharsee n 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 candidiasis
    • 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 sample, indicated by 1 of the following:
      • Presence of fungal elements indicating a mold
      • Recovery by culture of a mold (eg, Aspergillus, Fusarium, Zygomycetes, or Scedosporium species)
  • Indirect tests (detection of antigen or cell-wall constituents)
    • Aspergillosis: galactomannan antigen detected in plasma, serum, bronchoalveolar lavage fluid, or CSF
    • Invasive fungal disease other