Dear Friends:CALL FOR COMMENTS! EORTC/BAMSG Consensus Revised definitions draft VI.... Due primarily to the increase in the frequency of opportunistic invasive fungal infections and the lack of diagnostic criteria, there has been a great demand for development of standard definitions for diagnosis of these infections. You can view and/or download a documentation of the proposed revised definitions by clicking here. In addition, you can also view and/or download the PowerPoint presentations made at the ICAAC 2005 symposium "Defining Invasive Fungal Infections: New Directions" during which the revised definitions were discussed by clicking here. All feedback will be appreciated and should be submitted in the next 30 days. Please address all comments to J Peter Donnelly PhD, who has done an outstanding job leading this process! Thanks! Tom Patterson, Mike McGinnis, Sevtap Arikan, Mitchell Kirsch, Yuko Ejiri &the entire doctorfungus team | | UPCOMING EVENTS | | | USEFUL SITES | |  | | |  | | |  | | |  | | | 
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|  | DEFINING INVASIVE FUNGAL INFECTIONS IN IMMUNOCOMPROMISED PATIENTS: WHERE ARE WE NOW? Due primarily to the increase in the frequency of opportunistic invasive fungal infections and the lack of diagnostic criteria, there has been a great demand for development of standard definitions for diagnosis of these infections. Following a review of the literature and the consensus between the members of European Organization of Research and Treatment of Cancer (EORTC)/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG), definitions were proposed for invasive fungal infections in immunocompromised patients (1). These definitions categorize the infections as "proven", "probable", or "possible" according to the level of certainty and on the basis of the host factors, and microbiological and clinical criteria. Importantly, they were developed to be used for clinical and/or epidemiological research, but not for clinical decision-making. Since their proposal, the invasive fungal infection definitions were extensively used to make comparisons between clinical studies and to collect epidemiological data. In the interim, it became apparent that reconsideration of the appropriateness and adequacy of the current definitions is needed (2). Thus, following the initial proposal, the invasive fungal infection definitions are now to be revised. The major changes proposed in the revised version & the reasons why revisions were needed- The term "Invasive Fungal Infection" is changed to "Invasive Fungal Disease".
- Possible invasive fungal disease is now defined as at least one host factor and one clinical criterion (including imaging signs) characteristic of invasive fungal disease, but no microbiological evidence.
The initial definition of "possible" disease was based on the existence of at least one host factor together with the presence of one microbiological or one major (2 minor) clinical criteria. Since this old definition left some of the cases unclassified, it is now revised as above.
- Host factors were revised and now include also patients with primary immunodeficiencies and those receiving T-cell suppressants other than corticosteroids.
These newly added host factors also predispose to invasive fungal infections and this shortcoming is now fulfilled with the corresponding revision. The new whole list of host factors includes recipients of allogeneic stem cell transplants, prolonged use of corticosteroids, treatment with other T-cell immunosuppressants, and inherited severe immunodeficiency.
- The clinical criteria are not assigned as "major" or "minor" anymore. In the revised version, they are in the same key and wholely referred to as "clinical criteria".
- Detection of ß-D-glucan in BAL, CSF or blood is now included among the microbiological criteria.
Based on the presence of a standardized assay and the favorable results so far obtained, positivity of a single serum sample for ß-D-glucan is now a microbiological criterion.
Final word The revised definitions for invasive fungal infections appear to provide enhanced appropriateness and utility. The revisions are now open for discussion and will then be finally documented. Importantly and once again, these definitions are designed for clinical research but not for clinical care. Related reading- Ascioglu, S., J. H. Rex, B. de Pauw, J. E. Bennett, J. Bille, F. Crokaert, D. W. Denning, J. P. Donnelly, J. E. Edwards, Z. Erjavec, D. Fiere, O. Lortholary, J. Maertens, J. F. Meis, T. F. Patterson, J. Ritter, D. Selleslag, P. M. Shah, D. A. Stevens, and T. J. Walsh. 2002. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: An international consensus. Clin Infect Dis 34:7-14.
- de Pauw B. E., T. F. Patterson. 2005. Should the consensus guidelines' specific criteria for the diagnosis of invasive fungal infection be changed? Clin Infect Dis 41 Suppl 6:S377-80
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| | Name that Fungus! At doctorfungus.org we have detailed data on approximately 80 fungal genera. You can view themhere. In addition, our genus-species database provides nomenclature information on more than 1400 species from almost 400 genera. You can access this part of the website here Got a Link? Doctorfungus has over 100 links to various on-line resources that we considered potentially useful to you. Are there any that we missed? Do you have one that you believe we should add? See our list of on-line resources here, and let us knowwhat you'd like us to add!Quick Quiz! Which species name has been associated with the most different genera? Give up? Find the answer here. 
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|  | To sort out all those crazy fungal names, we've created this index. It currently contains data on ~1,000 species from ~400 different genera!>>Check it out<< |
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