Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium

Author:

Donnelly J Peter1,Chen Sharon C2,Kauffman Carol A3,Steinbach William J4,Baddley John W5,Verweij Paul E6,Clancy Cornelius J7,Wingard John R8,Lockhart Shawn R9,Groll Andreas H10,Sorrell Tania C11,Bassetti Matteo12,Akan Hamdi13,Alexander Barbara D14,Andes David15,Azoulay Elie16,Bialek Ralf17,Bradsher Robert W18,Bretagne Stephane19,Calandra Thierry20,Caliendo Angela M21,Castagnola Elio22,Cruciani Mario23,Cuenca-Estrella Manuel24,Decker Catherine F25,Desai Sujal R26,Fisher Brian27,Harrison Thomas28,Heussel Claus Peter29,Jensen Henrik E30,Kibbler Christopher C31,Kontoyiannis Dimitrios P32,Kullberg Bart-Jan33,Lagrou Katrien34,Lamoth Frédéric35,Lehrnbecher Thomas36,Loeffler Jurgen37,Lortholary Olivier38,Maertens Johan3940,Marchetti Oscar20,Marr Kieren A41,Masur Henry42,Meis Jacques F43,Morrisey C Orla44,Nucci Marcio45,Ostrosky-Zeichner Luis46,Pagano Livio47,Patterson Thomas F48,Perfect John R14,Racil Zdenek49,Roilides Emmanuel50,Ruhnke Marcus51,Prokop Cornelia Schaefer52,Shoham Shmuel41,Slavin Monica A53,Stevens David A5455,Thompson George R56,Vazquez Jose A57,Viscoli Claudio58,Walsh Thomas J59,Warris Adilia60,Wheat L Joseph61,White P Lewis62,Zaoutis Theoklis E63,Pappas Peter G5

Affiliation:

1. Department of Hematology, Radboudumc, Nijmegen, The Netherlands

2. Centre for Infectious Diseases and Microbiology, Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, University of Sydney, Sydney, Australia

3. Division of Infectious Diseases, University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA

4. Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA

5. Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA

6. Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands

7. University of Pittsburgh, Pittsburg, Pennsylvania, USA

8. Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA

9. Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

10. Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology University Children’s Hospital, Münster, Germany

11. University of Sydney, Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney School of Medicine Faculty of Medicine and Health, Westmead Institute for Centre for Infectious Diseases and Microbiology, Western Sydney Local Health District, Sydney, Australia

12. Infectious Disease Clinic, Department of Medicine University of Udine and Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy

13. Ankara University, Faculty of Medicine, Cebeci Campus, Hematology Clinical Research Unit, Ankara, Turkey

14. Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA

15. Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology School of Medicine and Public Health and School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA

16. Médicine Intensive et Réanimation Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France

17. Molecular Diagnostics of Infectious Diseases, Microbiology, LADR Zentrallabor Dr. Kramer & Kollegen, Geesthacht, Germany

18. Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

19. Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, Mycology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France

20. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

21. Department of Medicine, Alpert Warren Medical School of Brown University, Providence, Rhode Island, USA

22. Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy

23. Infectious Diseases Unit, G. Fracastoro Hospital, San Bonifacio, Verona, Italy

24. Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain

25. Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

26. National Heart & Lung Institute, Imperial College London, the Royal Brompton & Harefield NHS Foundation Trust, London, UK

27. Pediatric Infectious Diseases Division at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

28. Centre for Global Health, Institute for Infection and Immunity, St Georges University of London, London, UK

29. Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center and Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany

30. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

31. Centre for Medical Microbiology, University College London, London, UK

32. UT MD Anderson Cancer Center, Houston, Texas, USA

33. Radboud Center for Infectious Diseases and Department of Medicine, Radboudumc, Nijmegen, The Netherlands

34. Department of Microbiology, Immunology and Transplantation and Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium

35. Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

36. Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany

37. Molecular Biology and Infection, Medical Hospital II, WÜ4i, University Hospital Würzburg, Würzburg, Germany

38. Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine & Institut Pasteur, Molecular Mycology Unit, CNRS UMR 2000, Paris, France

39. Department of Hematology, University Hospitals Leuven, Leuven, Belgium

40. Department of Microbiology, Immunology and Transplantation, K.U. Leuven, Leuven, Belgium

41. Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School

42. Critical Care Medicine Department NIH-Clinical Center, Bethesda, Maryland, USA

43. Department of Medical Microbiology and Infectious Diseases and Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

44. Alfred Health and Monash University, Melbourne, Australia

45. Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

46. Division of Infectious Diseases, McGovern Medical School, Houston, Texas, USA

47. Istituto di Ematologia, Università Cattolica S. Cuore, Rome, Italy

48. UT Health San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA

49. Department of Internal Medicine–Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic

50. Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece

51. Department of Hematology & Oncology, Lukas Hospital, Buende, Germany

52. Meander Medical Center Amersfoort and Radiology, Radboud University Medical Center, Nijmegen, The Netherlands

53. Department of Infectious Diseases, Peter MacCallum Cancer Center and the National Centre for Infections in Cancer, The University of Melbourne, Melbourne, Victoria, Australia

54. Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California

55. California Institute for Medical Research, San Jose, California, USA

56. Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, USA

57. Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA

58. Division of Infectious Disease, University of Genova and San Martino University Hospital, Genova, Italy

59. Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, Microbiology & Immunology, New York, New York, USA

60. MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen, UK

61. MiraVista Diagnostics, Indianapolis, Indiana, USA

62. Public Health Wales Mycology Reference Laboratory, University Hospital of Wales, Heath Park, Cardiff, UK

63. Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia and Roberts Center for Pediatric Research, Philadelphia, Pennsylvania, USA

Abstract

Abstract Background Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. Methods To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups’ findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. Results There is no change in the classifications of “proven,” “probable,” and “possible” IFD, although the definition of “probable” has been expanded and the scope of the category “possible” has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. Conclusions These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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