Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium
Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium
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DOI：
10.1093/cid/ciz1008
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发表时间：
2020-09-15
影响因子：
11.8
通讯作者：
Pappas, Peter G.
中科院分区：
文献类型：
--
作者：
Donnelly, J. Peter;Chen, Sharon C.;Pappas, Peter G.
背景：侵袭性真菌病（IFDs）仍然是发病率和死亡率的重要原因。欧洲癌症研究和治疗组织传染病组和真菌病研究组的共识定义对进行抗真菌药物临床试验、评估诊断测试和进行流行病学研究的研究人员具有巨大价值。然而，它们的用途并没有扩展到癌症患者或干细胞或实体器官移植的接受者。随着新的诊断技术的出现，这些定义的更新显然是必不可少的。方法：为了实现这一目标，10个工作组密切关注影像、实验室诊断和有IFD风险的特殊人群。在一个科学研讨会上公布了这些研究结果，并经过3个月的公众评论期后，手稿的最终版本获得了一致同意。经过几轮讨论，手稿的最终定稿才得到批准。结果“已证实”、“可能”和“可能”IFD的分类没有变化，但“可能”的定义扩大了，“可能”的范围缩小了。经证实的IFD类别可适用于任何患者，无论患者是否免疫功能低下。除地方性真菌病外，仅针对免疫功能低下患者提出了可能和可能的分类。结论：这些更新的ifd定义应被证明适用于更大范围的高危患者的临床、诊断和流行病学研究。欧洲癌症研究和治疗组织和真菌病研究组对可能侵袭性真菌疾病的定义现在包括实体器官移植、血液恶性肿瘤、移植物抗宿主病、反晕征、半乳甘露聚糖、曲霉聚合酶链反应的修订阈值，以及念珠菌病、隐球菌病、非人类免疫缺陷病毒相关肺囊虫病和地方性真菌病的定义。
Background Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential.Methods To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved.Results There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses.Conclusions These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.European Organization for Research and Treatment of Cancer and the Mycoses Study Group definitions for probable invasive fungal disease now include solid organ transplant, hematologic malignancy, graft-versus-host disease, the reverse halo sign, revised thresholds for galactomannan, Aspergillus polymerase chain reaction, and definitions for candidiasis, cryptococcosis, non-human immunodeficiency viirus-associated pneumocystosis, and endemic mycoses.