Treatment of invasive fungal disease: A case report

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

Endemic mycoses include histoplasmosis, blastomycosis, coccidioidomycosis, paracoccidioidomycosis, sporotrichosis, and infection due to Penicillium marneffei. Onset within 3 mo after presentation defines a primary pulmonary infection. There is no category of possible endemic mycosis, as such, because neither host factors nor clinical features are sufficiently specific; such cases are considered to be of value too limited to include in clinical trials, epidemiological studies, or evaluations of diagnostic test. CSF: Cerebrospinal fluid.