Treatment of invasive fungal disease: A case report

Table 1 Criteria for proven invasive fungal disease except for endemic mycoses

Analysis and specimen	Molds1	Yeasts1
Microscopic analysis: Sterile material	Histopathologic, 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 damage	Histopathologic, 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 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 mold4 (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

¹If culture is available, append the identification at the genus or species level from the culture results.

²Tissue and cells submitted for histopathologic or cytopathologic studies should be stained by Grocott-Gomorri methenamine silver stain or by periodic acid Schiff stain, to facilitate inspection of fungal structures. Whenever possible, wet mounts of specimens from foci related to invasive fungal disease should be stained with a fluorescent dye (e.g., calcofluor or blankophor).

³Candida, Trichosporon, and yeast-like Geotrichum species and Blastoschizomyces capitatus may also form pseudohyphae or true hyphae.

⁴Recovery of Aspergillus species from blood cultures invariably represents contamination. CSF: Cerebrospinal fluid.