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.

Alfred Health and Monash University Melbourne Australia

Ankara University Faculty of Medicine Cebeci Campus Hematology Clinical Research Unit Ankara Turkey

California Institute for Medical Research San Jose California USA

Center of Expertise in Mycology Radboudumc CWZ Nijmegen The Netherlands

Centre for Global Health Institute for Infection and Immunity St Georges University of London London UK

Centre for Infectious Diseases and Microbiology Laboratory Services Institute of Clinical Pathology and Medical Research Westmead Hospital University of Sydney Sydney Australia

Centre for Medical Microbiology University College London London UK

Critical Care Medicine Department NIH Clinical Center Bethesda Maryland USA

Department of Hematology and Oncology Lukas Hospital Buende Germany

Department of Hematology Radboudumc Nijmegen The Netherlands

Department of Hematology University Hospitals Leuven Leuven Belgium

Department of Infectious Diseases Peter MacCallum Cancer Center and the National Centre for Infections in Cancer The University of Melbourne Melbourne Victoria Australia

Department of Internal Medicine Division of Infectious Diseases University of California Davis Medical Center Sacramento California USA

Department of Internal Medicine Hematology and Oncology Masaryk University and University Hospital Brno Brno Czech Republic

Department of Internal Medicine Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil

Department of Medical Microbiology and Infectious Diseases and Centre of Expertise in Mycology Radboudumc Canisius Wilhelmina Hospital Nijmegen The Netherlands

Department of Medicine Alpert Warren Medical School of Brown University Providence Rhode Island USA

Department of Medicine and Division of Infectious Diseases Duke University Medical Center Durham North Carolina USA

Department of Medicine Division of Infectious Diseases Johns Hopkins University School

Department of Medicine Division of Infectious Diseases University of Alabama at Birmingham Birmingham Alabama USA

Department of Medicine University of Florida College of Medicine Gainesville Florida USA

Department of Microbiology Immunology and Transplantation and Department of Laboratory Medicine and National Reference Centre for Mycosis University Hospitals Leuven Leuven Belgium

Department of Microbiology Immunology and Transplantation K U Leuven Leuven Belgium

Department of Pediatrics Duke University Medical Center Durham North Carolina USA

Diagnostic and Interventional Radiology University Hospital Heidelberg Translational Lung Research Center and Diagnostic and Interventional Radiology with Nuclear Medicine Thoraxklinik Heidelberg Heidelberg Germany

Division of Infectious Disease University of Genova and San Martino University Hospital Genova Italy

Division of Infectious Diseases and Geographic Medicine Stanford University Medical School Stanford California

Division of Infectious Diseases Departments of Medicine Microbiology and Immunology School of Medicine and Public Health and School of Pharmacy University of Wisconsin Madison Wisconsin USA

Division of Infectious Diseases McGovern Medical School Houston Texas USA

Division of Infectious Diseases Medical College of Georgia Augusta University Augusta Georgia USA

Division of Infectious Diseases University of Arkansas for Medical Sciences Little Rock Arkansas USA

Division of Infectious Diseases University of Michigan VA Ann Arbor Healthcare System Ann Arbor Michigan USA

Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Infectious Disease Clinic Department of Medicine University of Udine and Department of Health Sciences DISSAL University of Genoa Genoa Italy

Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology University Children's Hospital Münster Germany

Infectious Diseases Division Department of Medicine Uniformed Services University of the Health Sciences Bethesda Maryland USA

Infectious Diseases Service Department of Medicine and Institute of Microbiology Lausanne University Hospital and University of Lausanne Lausanne Switzerland

Infectious Diseases Service Department of Medicine Lausanne University Hospital and University of Lausanne Lausanne Switzerland

Infectious Diseases Unit 3rd Department of Pediatrics Faculty of Medicine Aristotle University School of Health Sciences Hippokration General Hospital Thessaloniki Greece

Infectious Diseases Unit G Fracastoro Hospital San Bonifacio Verona Italy

Infectious Diseases Unit IRCCS Istituto Giannina Gaslini Genova Italy

Institut Pasteur Molecular Mycology Unit CNRS UMR2000 Mycology Laboratory Saint Louis Hospital Assistance Publique Hôpitaux de Paris Université de Paris Paris France

Istituto di Ematologia Università Cattolica S Cuore Rome Italy

Meander Medical Center Amersfoort and Radiology Radboud University Medical Center Nijmegen The Netherlands

Médicine Intensive et Réanimation Hôpital Saint Louis APHP Université Paris Diderot Paris France

MiraVista Diagnostics Indianapolis Indiana USA

Molecular Biology and Infection Medical Hospital 2 WÜ4i University Hospital Würzburg Würzburg Germany

Molecular Diagnostics of Infectious Diseases Microbiology LADR Zentrallabor Dr Kramer and Kollegen Geesthacht Germany

MRC Centre for Medical Mycology at the University of Aberdeen Aberdeen UK

Mycotic Diseases Branch Centers for Disease Control and Prevention Atlanta Georgia USA

National Heart and Lung Institute Imperial College London the Royal Brompton and Harefield NHS Foundation Trust London UK

Paris University Necker Pasteur Center for Infectious Diseases and Tropical Medicine IHU Imagine and Institut Pasteur Molecular Mycology Unit CNRS UMR 2000 Paris France

Pediatric Hematology and Oncology Hospital for Children and Adolescents University of Frankfurt Frankfurt Germany

Pediatric Infectious Diseases Division at the Children's Hospital of Philadelphia Philadelphia Pennsylvania USA

Perelman School of Medicine at the University of Pennsylvania Children's Hospital of Philadelphia and Roberts Center for Pediatric Research Philadelphia Pennsylvania USA

Public Health Wales Mycology Reference Laboratory University Hospital of Wales Heath Park Cardiff UK

Radboud Center for Infectious Diseases and Department of Medicine Radboudumc Nijmegen The Netherlands

Spanish National Centre for Microbiology Instituto de Salud Carlos 3 Madrid Spain

University of Pittsburgh Pittsburg Pennsylvania USA

University of Sydney Marie Bashir Institute for Infectious Diseases and Biosecurity University of Sydney School of Medicine Faculty of Medicine and Health Westmead Institute for Centre for Infectious Diseases and Microbiology Western Sydney Local Health District Sydney Australia

UT Health San Antonio and South Texas Veterans Health Care System San Antonio Texas USA

UT MD Anderson Cancer Center Houston Texas USA

Weill Cornell Medicine of Cornell University Departments of Medicine Pediatrics Microbiology and Immunology New York New York USA

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