DOI: 10.1093/cid/ciz1008 ISSN:

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

J Peter Donnelly, Sharon C Chen, Carol A Kauffman, William J Steinbach, John W Baddley, Paul E Verweij, Cornelius J Clancy, John R Wingard, Shawn R Lockhart, Andreas H Groll, Tania C Sorrell, Matteo Bassetti, Hamdi Akan, Barbara D Alexander, David Andes, Elie Azoulay, Ralf Bialek, Robert W Bradsher, Stephane Bretagne, Thierry Calandra, Angela M Caliendo, Elio Castagnola, Mario Cruciani, Manuel Cuenca-Estrella, Catherine F Decker, Sujal R Desai, Brian Fisher, Thomas Harrison, Claus Peter Heussel, Henrik E Jensen, Christopher C Kibbler, Dimitrios P Kontoyiannis, Bart-Jan Kullberg, Katrien Lagrou, Frédéric Lamoth, Thomas Lehrnbecher, Jurgen Loeffler, Olivier Lortholary, Johan Maertens, Oscar Marchetti, Kieren A Marr, Henry Masur, Jacques F Meis, C Orla Morrisey, Marcio Nucci, Luis Ostrosky-Zeichner, Livio Pagano, Thomas F Patterson, John R Perfect, Zdenek Racil, Emmanuel Roilides, Marcus Ruhnke, Cornelia Schaefer Prokop, Shmuel Shoham, Monica A Slavin, David A Stevens, George R Thompson, Jose A Vazquez, Claudio Viscoli, Thomas J Walsh, Adilia Warris, L Joseph Wheat, P Lewis White, Theoklis E Zaoutis, Peter G Pappas
  • Infectious Diseases
  • Microbiology (medical)



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.


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.


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.


These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.

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