Mucormycosis diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

An established criteria exists which can help in diagnosing mucormycosis. The criteria is provided by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. It is based on microscopic findings, clinical criteria and characteristics of the fungus.

Diagnostic Criteria[1][2]

Mucormycosis may be diagnosed using the definitions and criteria provided by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. It classifies invasive fungal infection as:

  • Proven invasive fungal disease except endemic mycosis
  • Probable invasive fungal disease except endemic mycosis
  • Criteria for diagnosis of endemic mycosis

Criteria for proven invasive fungal disease except for endemic mycoses

Analysis and specimen Molds Yeasts
Microscopic analysis Histopathologic, cytopathologic, or direct microscopic examination 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 damage Histopathologic, cytopathologic, or direct microscopic examination 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 hyphae
Sterile material Recovery 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 urine Recovery 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
Blood Blood culture that yields a mold (e.g., Fusarium species) in the context of a compatible infectious disease process Blood culture that yields yeast (e.g., Cryptococcus or Candida species) or yeast-like fungi (e.g., Trichosporon species)
Serological analysis: CSF Not applicable Cryptococcal antigen in CSF indicates disseminated cryptococcosis

Criteria for probable invasive fungal disease except for endemic mycoses

Host factors:

  • Recent history of neutropenia (<0.5 × 109 neutrophils/L [<500 neutrophils/mm3] for >10 days) temporally related to the onset of fungal disease.

Clinical criteria

  • Imaging showing sinusitis plus at least 1 of the following 3 signs:
  1. Acute localized pain (including pain radiating to the eye).
  2. Nasal ulcer with black eschar.
  3. Extension from the paranasal sinus across bony barriers, including into the orbit.
  • 1 of the following 2 signs:
  1. Focal lesions on imaging.
  2. Meningeal enhancement on MRI or CT.
  1. Small, target-like abscesses (bull's-eye lesions) in liver or spleen.
  2. Progressive retinal exudates on ophthalmologic examination.

Mycological criteria

  1. Presence of fungal elements indicating a mold.
  2. Recovery by culture of a mold (e.g., Aspergillus, Fusarium, Zygomycetes, or Scedosporium species).

Invasive fungal disease other than cryptococcosis and zygomycoses.

    • β-d-glucan detected in serum

Criteria for proven endemic mycosis

  • In a host with an illness consistent with an endemic mycosis, 1 of the following:
  1. Recovery in culture from a specimen obtained from the affected site or from blood.
  2. 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.

Probable endemic mycosis

References

  1. Hoenigl M, Strenger V, Buzina W, Valentin T, Koidl C, Wölfler A, Seeber K, Valentin A, Strohmeier AT, Zollner-Schwetz I, Raggam RB, Urban C, Lass-Flörl C, Linkesch W, Krause R (2012). "European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) host factors and invasive fungal infections in patients with haematological malignancies". J. Antimicrob. Chemother. 67 (8): 2029–33. doi:10.1093/jac/dks155. PMID 22566591.
  2. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE (2008). "Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group". Clin. Infect. Dis. 46 (12): 1813–21. doi:10.1086/588660. PMC 2671227. PMID 18462102.

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