Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group

Abstract

Background: Invasive fungal diseases are important causes of morbidity and mortality. Clarity and uniformity in defining these infections are important factors in improving the quality of clinical studies. A standard set of definitions strengthens the consistency and reproducibility of such studies.

Methods: After the introduction of the original European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group definitions, advances in diagnostic technology and the recognition of areas in need of improvement led to a revision of this document. The revision process started with a meeting of participants in 2003, to decide on the process and to draft the proposal. This was followed by several rounds of consultation until a final draft was approved in 2005. This was made available for 6 months to allow public comment, and then the manuscript was prepared and approved.

Results: The revised definitions retain the original classifications of "proven," "probable," and "possible" invasive fungal disease, but the definition of "probable" has been expanded, whereas the scope of the category "possible" has been diminished. The category of proven invasive fungal disease can apply to any patient, regardless of whether the patient is immunocompromised, whereas the probable and possible categories are proposed for immunocompromised patients only.

Conclusions: These revised definitions of invasive fungal disease are intended to advance clinical and epidemiological research and may serve as a useful model for defining other infections in high-risk patients.

Conflict of interest statement

Potential conflicts of interest. B.d.P. has been an advisor/consultant for Basilea Pharmaceutica and Ipsat Therapies and has been on the speakers' bureau for Gilead Sciences, Merck & Co (Merck), and Pfizer. J.P.D. has received grant support from AM-Pharma, Basilea Pharmaceutica, and Schering-Plough; has been an advisor/consultant for Gilead Sciences, Ipsat Therapies, and Pfizer; has been on the speakers' bureau for Gilead Sciences, Janssen Pharmaceuticals, Pfizer, Schering-Plough, and Xian-Janssen; and has received travel grants from Merck Sharp & Dohme and UCB Pharma. J.E.E. has been an advisor/consultant for Cerexa, Merck, and Pfizer; has received grant support from Gilead Sciences, the National Institutes of Health, Merck, and Pfizer; and holds shares of NovaDigm Therapeutics. T.C. has received grant support from Bio-Rad Laboratories, Essex Pharma, Merck, Roche Diagnostics, and Wako; has been an advisor/consultant for Essex Pharma, Merck Sharp & Dohme, Novartis, and Pfizer; and has been on the speakers' bureau for Merck Sharp & Dohme and Pfizer. P.G.P. has received grant support from Astellas Pharma, Merck, Pfizer, and Schering-Plough; has been an advisor/consultant for Astellas Pharma, Merck, Pfizer, and Schering-Plough; and has been on the speakers' bureau for Astellas Pharma, Merck, Pfizer, and Schering-Plough. J.M. has received grant support from Bio-Rad Laboratories, Merck Sharp & Dohme, and Schering-Plough; has been an advisor/consultant for Bio-Rad Laboratories, Fujisawa Healthcare, Gilead Sciences, Merck Sharp & Dohme, Nektar Therapeutics, Pfizer, Schering-Plough, and Zeneus (now Cephalon); and has been on the speakers' bureau for Bio-Rad Laboratories, Fujisawa Healthcare, Gilead Sciences, Merck Sharp & Dohme, Pfizer, Schering-Plough, and Zeneus (now Cephalon). O.L. has received grant support from Gilead Sciences, Merck Sharp & Dohme, and Pfizer and has been on the speakers' bureau for Astellas Pharma, Gilead Sciences, Merck Sharp & Dohme, Pfizer, and Schering-Plough. C.A.K. has received grant support from Astellas Pharma, Merck, and Schering-Plough and has been on the speakers' bureau for Astellas Pharma, Merck, Pfizer, and Schering-Plough. D.W.D. has received grant support from Astellas Pharma, Basilea Pharmaceutica, the Chronic Granulomatous Disease Research Trust, the European Union, F2G, the Fungal Research Trust, Indevus Pharmaceuticals, the Medical Research Council, Merck Sharp & Dohme, the Moulton Trust, the National Institute of Allergy and Infectious Diseases, Ortho-Biotech, Pfizer, and the Wellcome Trust; has been an advisor/consultant for Astellas Pharma, Basilea Pharmaceutica, Daiichi Sankyo, F2G, Gilead Sciences, Indevus Pharmaceuticals, Nektar Therapeutics, Pfizer, Schering-Plough, Sigma Tau, Vicuron (now Pfizer), and York Pharma; has been on the speakers' bureau for Astellas Pharma, Astra-Zeneca, Chiron, GlaxoSmithKline, Merck Sharp & Dohme, Pfizer, and Schering-Plough; and holds founder shares of F2G and Myconostica. T.F.P. has received grant support from Astellas Pharma, Enzon, Merck, Nektar Therapeutics, Pfizer, and Schering-Plough; has been an advisor/consultant for Basilea Pharmaceutica, Merck, Nektar Therapeutics, Pfizer, Schering-Plough, and Stiefel Laboratories; and has been on the speakers' bureau for Merck and Pfizer. G.M. has been an advisor/consultant for Gilead Sciences, Merck Sharp & Dohme, Pfizer, and Sanofi-Aventis; has been on the speakers' bureau for Amgen, Cephalon, Gilead Sciences, Merck Sharp & Dohme, Ortho-Biotech, and Pfizer; and has received travel grants from Amgen, Merck Sharp & Dohme, Novartis, Pfizer, and Roche. R.H. has received grant support from Pfizer; has been an advisor/consultant for Astellas Pharma, Gilead Sciences, Merck, Novartis, Pfizer, and Schering-Plough; and has been on the speakers' bureau for Gilead Sciences, Pfizer, and Schering-Plough. W.W.H. has received grant support from Astellas Pharma, Gilead Sciences, and Schering-Plough and has been an advisor/consultant for Pfizer. C.C.K. has received grant support from Gilead Sciences, Merck, and Pfizer and has been an advisor/consultant for Astellas Pharma, Gilead Sciences, ICN (now Valeant), Janssen, Merck, Pfizer, and Schering-Plough. B.J.K. has been an advisor/consultant for Basilea Pharmaceutica, F2G, Novartis, Pfizer, and Schering-Plough and has been on the speakers' bureau for Pfizer and Schering-Plough. K.A.M. has been an advisor/consultant for Astellas Pharma, Basilea Pharmaceutica, Enzon, Merck, Pfizer, and Schering-Plough. F.C.O. has received grant support from Merck and Sharp & Dohme; has been an advisor/consultant for Astellas Pharma, Italfarmaco, Merck Sharp & Dohme, Pfizer, Schering-Plough, and Syngenta; has been on the speakers' bureau for Astellas Pharma, Merck Sharp & Dohme, Pfizer, and Schering-Plough; and holds shares of Johnson & Johnson. J.R.P. has received grant support from Astellas Pharma, Enzon, Merck, Pfizer, and Schering-Plough; has been an advisor/consultant for Astellas Pharma, Enzon, Merck, Pfizer, and Schering-Plough; and has been on the speakers' bureau for Astellas Pharma, Enzon, Merck, Pfizer, and Schering-Plough. M.R. has received grant support from Merck Sharp & Dohme and Pfizer; has been an advisor/consultant for Basilea Pharmaceutica, Essex Pharma, Gilead Sciences, Merck Sharp & Dohme, Novartis, and Pfizer; and has been on the speakers' bureau for Essex Pharma, Gilead Sciences, Merck Sharp & Dohme, Novartis, and Pfizer. B.H.S. has received grant support from Pfizer; has been an advisor/consultant for Berlex Laboratories, Pfizer, and Schering-Plough; and has been on the speakers' bureau for Merck and Pfizer. J.D.S. has received grant support from Merck, the National Institutes of Health, and Pfizer; has been an advisor/consultant for Merck and Pfizer; and has been on the speakers' bureau for Merck, Pfizer, and Schering-Plough. T.C.S. has received grant support from Gilead Sciences, Merck Sharp & Dohme, and Pfizer and has been an advisor/consultant for Gilead Sciences, Merck Sharp & Dohme, Pfizer, and Schering-Plough. C.V. has been an advisor/consultant for Gilead Sciences, Novartis, and Schering-Plough and has been on the speakers' bureau for Gilead Sciences, Merck Sharp & Dohme, Pfizer, Schering-Plough, and Wyeth Pharmaceuticals. J.R.W. has received grant support from Merck and Pfizer; has been an advisor/consultant for Basilea Pharmaceutica, Merck, Nektar Therapeutics, and Pfizer; and has been on the speakers' bureau for Merck and Pfizer. T.Z. has received grant support from Merck. All other authors: no conflicts.