Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology

Hoenigl M 1 , Salmanton-García J 2 , Walsh TJ 3 , Nucci M 4 , Neoh CF 5 , Jenks JD 6 Show all authors , Lackner M 7 , Sprute R 8 , Al-Hatmi AMS 9 , Bassetti M 10 , Carlesse F 11 , Freiberger T 12 , Koehler P 13 , Lehrnbecher T 14 , Kumar A 15 , Prattes J 16 , Richardson M 17 , Revankar S 18 , Slavin MA 19 , Stemler J 8 , Spiess B 20 , Taj-Aldeen SJ 21 , Warris A 22 , Woo PCY 23 , Young JH 24 , Albus K 2 , Arenz D 25 , Arsic-Arsenijevic V 26 , Bouchara JP 27 , Chinniah TR 28 , Chowdhary A 29 , de Hoog GS 30 , Dimopoulos G 31 , Duarte RF 32 , Hamal P 33 , Meis JF 34 , Mfinanga S 35 , Queiroz-Telles F 36 , Patterson TF 37 , Rahav G 38 , Rogers TR 39 , Rotstein C 40 , Wahyuningsih R 41 , Seidel D 42 , Cornely OA 43

Affiliations 

  • 1 Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA; Clinical and Translational Fungal Research Working Group, University of California San Diego, San Diego, CA, USA; European Confederation of Medical Mycology Council, Basel, Switzerland. Electronic address: hoeniglmartin@gmail.com
  • 2 Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
  • 3 Department of Medicine, Department of Pediatrics, and Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, USA; New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
  • 4 Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
  • 5 Faculty of Pharmacy, and Collaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences, Community of Research, Universiti Teknologi MARA, Selangor, Malaysia
  • 6 Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA; Clinical and Translational Fungal Research Working Group, University of California San Diego, San Diego, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California San Diego, San Diego, CA, USA
  • 7 Institute of Hygiene and Medical Microbiology, Department of Hygiene, Medical Microbiology and Publics Health, Medical University Innsbruck, Innsbruck, Austria
  • 8 Faculty of Medicine, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
  • 9 Department of Microbiology, Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
  • 10 Division of Infections Diseases, Department of Health Sciences, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
  • 11 Department of Pediatrics, and Pediatric Oncology Institute IOP-GRAACC-UNIFESP, Federal Univeristy of São Paulo, São Paulo, Brazil
  • 12 Centre for Cardiovascular Surgery and Transplantation, and Faculty of Medicine, Masaryk University, Brno, Czech Republic
  • 13 Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
  • 14 Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Frankfurt, Germany
  • 15 Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
  • 16 Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
  • 17 Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, Manchester, UK
  • 18 Division of Infectious Diseases, Wayne State University, Detroit, MI, USA
  • 19 University of Melbourne, Melbourne, VIC, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  • 20 Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
  • 21 Department of Laboratory Medicne and Pathology, Hamad Medical Corporation, Doha, Qatar
  • 22 Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
  • 23 Department of Microbiology, University of Hong Kong, Hong Kong, China
  • 24 University of Minnesota, Minneapolis, MN, USA
  • 25 Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
  • 26 National Reference Laboratory for Medical Mycology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; European Confederation of Medical Mycology Council, Basel, Switzerland
  • 27 Host-Pathogen Interaction Study Group, and Laboratory of Parasitology and Mycology, Angers University Hospital, Angers University, Angers, France
  • 28 Department of Microbiology, University of Colombo, Colombo, Sri Lanka
  • 29 Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
  • 30 Center of Expertise in Mycology, Radboud University Medical Center-Canisius Wilhelmina Hospital, Nijmegen, Netherlands
  • 31 Critical Care Department, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
  • 32 University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
  • 33 Department of Microbiology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic; European Confederation of Medical Mycology Council, Basel, Switzerland
  • 34 Department of Medical Microbiology and Infectious Diseases, Radboud University Medical Center-Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Center of Expertise in Mycology, Radboud University Medical Center-Canisius Wilhelmina Hospital, Nijmegen, Netherlands; European Confederation of Medical Mycology Council, Basel, Switzerland
  • 35 National Institute for Medical Research, Tanzania; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
  • 36 Department of Public Health, Clinics Hospital, Federal University of Parana, Curitiba, Brazil
  • 37 UT Health San Antonio and South Texas Veterans Health Care System, San Antonio, TX, USA
  • 38 Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  • 39 Department of Clinical Microbiology, Trinity College Dublin, St James's Hospital Campus, Dublin, Ireland
  • 40 Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada
  • 41 Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
  • 42 Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
  • 43 Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany; European Confederation of Medical Mycology Council, Basel, Switzerland
Lancet Infect Dis, 2021 Aug;21(8):e246-e257.
PMID: 33606997 DOI: 10.1016/S1473-3099(20)30784-2

Abstract

With increasing numbers of patients needing intensive care or who are immunosuppressed, infections caused by moulds other than Aspergillus spp or Mucorales are increasing. Although antifungal prophylaxis has shown effectiveness in preventing many invasive fungal infections, selective pressure has caused an increase of breakthrough infections caused by Fusarium, Lomentospora, and Scedosporium species, as well as by dematiaceous moulds, Rasamsonia, Schizophyllum, Scopulariopsis, Paecilomyces, Penicillium, Talaromyces and Purpureocillium species. Guidance on the complex multidisciplinary management of infections caused by these pathogens has the potential to improve prognosis. Management routes depend on the availability of diagnostic and therapeutic options. The present recommendations are part of the One World-One Guideline initiative to incorporate regional differences in the epidemiology and management of rare mould infections. Experts from 24 countries contributed their knowledge and analysed published evidence on the diagnosis and treatment of rare mould infections. This consensus document intends to provide practical guidance in clinical decision making by engaging physicians and scientists involved in various aspects of clinical management. Moreover, we identify areas of uncertainty and constraints in optimising this management.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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