Defining invasive fungal infections in neutropenic or stem cell transplant patients

Consistent definition of invasive fungal infection is important for managing individual patients, for conducting clinical trials and for evaluating diagnostic tests. However, a recent systematic review of the literature found that at least 25 adverbs have been used to categorize infections and when the criteria in these papers were applied to a single database of patients with fungal infections, there was little agreement. This is the consequence of the varying sensitivity and specificity of different clinical features and investigations in different patient groups and an inconsistency in their application. This review examines the clinical presentation of invasive fungal infections in neutropenic patients and those receiving stem cell transplants, as well as the performance of currently available investigations, in order to consider their value as invasive fungal infection criteria. The recent publication of the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions has provided an international standard for the performance of clinical research in this group of patients. The definitions committee has now been reconvened to consider some of the criticisms of the original criteria and these are likely to evolve further in the future.