Mucormycosis diagnostic criteria
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Mucormycosis Microchapters |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
Diagnostic Criteria
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: sterile material | 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 examinationb 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
- 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, TNF-α blockers, 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
- Lower respiratory tract fungal disease
- 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 eschar seen on bronchoscopic analysis
- Sino-nasal 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 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)
- 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
Proven endemic mycosis
- In a host with an illness consistent with an endemic mycosis, 1 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 2 consecutive blood samples tested concurrently in the setting of an ongoing infectious disease process
- For paracoccidioidomycosis, demonstration in 2 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, plus a clinical picture consistent with endemic mycosis and mycological evidence, such as a positive Histoplasma antigen test result from urine, blood, or CSF