Case Report
Copyright ©The Author(s) 2019.
World J Clin Cases. Aug 26, 2019; 7(16): 2374-2383
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2374
Table 1 Criteria for proven invasive fungal disease except for endemic mycoses
Analysis and specimenMolds1Yeasts1
Microscopic analysis: Sterile materialHistopathologic, cytopathologic, or direct microscopic examination2 of a specimen obtained by needle aspiration or biopsy in which hyphae or melanized yeast-like forms are seen accompanied by evidence of associated tissue damageHistopathologic, cytopathologic, or direct microscopic examination2 of a specimen obtained by needle aspiration or biopsy from a normally sterile site (other than mucous membranes) showing yeast cells - for example, Cryptococcus species indicated by encapsulated budding yeasts or Candida species showing pseudohyphae or true hyphae3
Culture; Sterile materialRecovery of a mold or “black yeast” by culture of a specimen obtained by a sterile procedure from a normally sterile and clinically or radiologically abnormal site consistent with an infectious disease process, excluding bronchoalveolar lavage fluid, a cranial sinus cavity specimen, and urineRecovery of a yeast by culture of a sample obtained by a sterile procedure [including a freshly placed (< 24 h ago) drain] from a normally sterile site showing a clinical or radiological abnormality consistent with an infectious disease process
BloodBlood culture that yields a mold4 (e.g., Fusarium species) in the context of a compatible infectious disease processBlood culture that yields yeast (e.g., Cryptococcus or Candida species) or yeast- like fungi (e.g., Trichosporon species)
Serological analysis: CSFNot applicableCryptococcal antigen in CSF indicates disseminated cryptococcosis
Table 2 Criteria for probable invasive fungal disease except for endemic mycoses
Host factors1
Recent history of neutropenia [< 0.5 × 109 neutrophils/L (< 500 neutrophils/mm3] for > 10 d] 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/d of prednisone equivalent for > 3 wk
Treatment with other recognized T cell immunosuppressants, such as cyclosporine, TNF-α blockers, specific monoclonal antibodies (such as alemtuzumab), or nucleoside analogues during the past 90 d
Inherited severe immunodeficiency (such as chronic granulomatous disease or severe combined immunodeficiency)
Clinical criteria2
Lower respiratory tract fungal disease3
The presence of one of the following three 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 eschar seen on bronchoscopic analysis
Sinonasal infection
Imaging showing sinusitis plus at least one of the following three 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
One of the following two signs:
Focal lesions on imaging
Meningeal enhancement on MRI or CT
Disseminated candidiasis4
At least one of the following two entities after an episode of candidemia within the previous 2 wk:
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 samples, indicated by 1 of the following:
Presence of fungal elements indicating a mold
Recovery by culture of a mold (e.g., Aspergillus, Fusarium, Zygomycetes, or Scedosporium species)
Indirect tests (detection of antigen or cell-wall constituents)5
Aspergillosis
Galactomannan antigen detected in plasma, serum, bronchoalveolar lavage fluid, or CSF
Invasive fungal disease other than cryptococcosis and zygomycoses
β-D-glucan detected in serum
Table 3 Criteria for the diagnosis of endemic mycoses
Diagnosis and criteria
Proven endemic mycosis
In a host with an illness consistent with an endemic mycosis, one of the following:
Recovery in culture from a specimen obtained from the affected site or from blood
Histopathologic or direct microscopic demonstration of appropriate morphologic forms with a truly distinctive appearance characteristic of dimorphic fungi, such as Coccidioides species spherules, Blastomyces dermatitidis thick-walled broad-based budding yeasts, Paracoccidioides brasiliensis multiple budding yeast cells, and, in the case of histoplasmosis, the presence of characteristic intracellular yeast forms in a phagocyte in a peripheral blood smear or in tissue macrophages
For coccidioidomycosis, demonstration of coccidioidal antibody in CSF, or a 2-dilution rise measured in two consecutive blood samples tested concurrently in the setting of an ongoing infectious disease process
For paracoccidioidomycosis, demonstration in two consecutive serum samples of a precipitin band to paracoccidioidin concurrently in the setting of an ongoing infectious disease process
Probable endemic mycosis
Presence of a host factor, including but not limited to those specified in Table 2, plus a clinical picture consistent with endemic mycosis and mycological evidence, such as a positive Histoplasma antigen test result from urine, blood, or CSF