In 2002, a consensus group of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) published standard definitions for invasive fungal infections for clinical and epidemiological research . These definitions were developed to facilitate the identification of reasonably homogeneous groups of patients for clinical and epidemiologic research, to help design clinical trials to evaluate new drugs and management strategies, and, last but not least, to foster communication between international researchers. The definitions assigned 3 levels of probability to the diagnosis of invasive fungal infection that develops in immunocompromised patients with cancer and in hematopoietic stem cell transplant recipients—namely, “proven,” “probable,” and “possible” invasive fungal infection. The definitions established a formal framework for defining invasive fungal infection with a variable certainty of diagnosis. Proven invasive fungal infection required only that a fungus be detected by histological analysis or culture of a specimen of tissue taken from a site
of disease; in the case of Cryptococcus neoformans, detection of capsular antigen in CSF or a positive result of an India ink preparation of CSF was considered sufficient to establish a diagnosis of proven cryptococcosis. By contrast, probable and possible invasive fungal infections hinged on 3 elements—namely, a host factor that identified the patients at risk, clinical signs and symptoms consistent with the disease entity, and mycological evidence that encompassed culture and microscopic analysis but also indirect tests, such as antigen detection.
These EORTC/MSG Consensus Group definitions have been used in major trials of antifungal drug efficacy, in strategy trials , for the formulation of clinical practice guidelines, for validation of diagnostic tests , and for performance of epidemiologic studies.
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