Types of indications for antifungal therapy:
(1) definitely indicated
(2) strongly indicated
(3) probably indicated
(4) not indicated (none of the above)
Antifungal therapy definitely indicated - one or more of the following:
(1) high risk patient AND positive respiratory tract culture for fungus
(2) positive histology or cytology findings for invasive fungal infection
(3) history of invasive fungal infection AND current immunosuppression
(4) positive culture result from a "sterile" site (CSF, blood, other)
(5) high risk patient AND clinical findings suggestive of invasive fungal infection AND 2 consecutive positive results for galactomannan (ELISA, PCR)
Antifungal therapy strongly indicated - all of the following:
(1) patient at high risk for fungal infection
(2) persistent fever and immunosuppression
(3) one or more clinical or radiologic findings suggestive of an invasive fungal infection
(3a) unexplained facial and/or sinus pain
(3b) unexplained hoarseness
(3c) skin lesions consistent with an invasive fungal infection
(3d) endophthalmitis consistent with an invasive fungal infection
(3e) unexplained pulmonary embolus
(3f) unexplained myocardial infarction
(3g) unexplained stroke (cerebrovascular accident)
(3h) unexplained Budd-Chiari syndrome
(3i) other unexplained vascular accident
(3j) unexplained tracheobronchitis
(3k) halo sign on CT of chest AND compatible clinical findings
(3l) air crescent sign on chest imaging studies AND compatible clinical findings
(3m) nodular lesions on chest imaging studies AND compatible clinical findings
(3n) pleural-based lesion, sharply angulated AND compatible clinical findings
(3o) unexplained pneumothorax
where:
• Unexplained findings are those that cannot be explained by a known cause and for which the patient does not otherwise have risk for.
Antifungal therapy probably indicated - all of the following:
(1) patient at high risk for fungal infection
(2) persistent fever and neutropenia
(3) new pulmonary infiltrate in the absence of a known cause
