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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. [ABSTRACT FROM AUTHOR]

Background: The new Rasamsonia spp. complex can develop invasive infection in immunosuppression or chronic pulmonary disease. It has potential to be misidentified as other genera due to morphological similarities. Nowadays, there is a gap of knowledge on this fungi., Objectives: To provide knowledge base of risk factors and therapeutic decisions in invasive Rasamsonia spp. complex infection., Patients/methods: Cases of invasive infection due to Rasamsonia spp. (formerly Geosmithia/Penicillium spp.) from FungiScope ® registry and all reported cases from a literature were included., Results: We identified 23 invasive infections due to Rasamsonia spp., six (26.1%) in the FungiScope ® registry. Main risk factors were chronic granulomatous disease (n = 12, 52.2%), immunosuppressive treatment (n = 10, 43.5%), haematopoietic stem cell transplantation (n = 7, 30.4%), graft-versus-host disease and major surgery (n = 4, 17.4%, each). Predominantly affected organs were the lungs (n = 21, 91.3%), disease disseminated in seven cases (30.4%). Fungal misidentification occurred in 47.8% (n = 11), and sequencing was used in 69.6% of the patients (n = 16) to diagnose. Breakthrough infection occurred in 13 patients (56.5%). All patients received antifungal treatment, mostly posaconazole (n = 11), caspofungin (n = 10) or voriconazole (n = 9). Combination therapy was administered in 13 patients (56.5%). Susceptibility testing showed high minimum inhibitory concentrations for azoles and amphotericin B, but not for echinocandins. No preferable treatment influencing favourable outcome was identified. Overall mortality was 39% (n = 9)., Conclusion: Rasamsonia spp. are emerging fungi causing life-threatening infections, especially in immunocompromised and critically ill patients. Mortality is high. Treatment is challenging and clinicians dealing with this patient population should become aware of this infection constituting a medical emergency., (© 2019 The Authors. Mycoses published by Blackwell Verlag GmbH.)

Background: Refractory invasive aspergillosis (IA) is a life-threatening condition. Cost of treatment, although secondary, is important if newer drugs are to be widely accepted. Posaconazole has been shown to have activity against aspergillosis., Methods: Analyses were conducted to compare the effectiveness and cost of posaconazole 800 mg/day with those of standard antifungal therapy, using Walsh et al. 2007 data. All-cause mortality and total drug costs were analyzed for three patient groups: All Refractory, Refractory Non-neutropenic, and Refractory Neutropenic IA Patients. Comparative survival analysis using Kaplan-Meier estimates after censoring data at 28, 42, 84, 182, and 365 days and Cox proportional hazard method was used to estimate hazard rates after controlling for difference in baseline neutropenia. For cost analysis, only antifungal drug acquisition cost was used., Results: Significantly more of the 94 patients treated with posaconazole remained alive at every time point compared with the 68 external control patients within the All Refractory group (p = 0.0001). Similar results were obtained for the other two groups. For the posaconazole-treated patients mean total drug costs were $11846 (±$12406), $12642 (±$11811), and $8903 (±$14345), and for the external controls total drug costs were $35537 (±$73059), $48097 (±$88702), and $13556 (±$16324) for the All Refractory, Refractory Non-neutropenic, and Neutropenic IA groups, respectively. Key limitations of the study included noninclusion of hospitalization or other drug costs, low patient numbers beyond 84 days, and the fact that the Walsh et al. 2007 study was completed before other newer antifungal agents (such as voriconazole and caspofungin) were available., Conclusions: Posaconazole appears to confer a survival benefit and reduced total drug cost compared with standard antifungal therapy, such as amphotericin B (lipid and nonlipid formulations), itraconazole, or both, to treat patients with probable or proven refractory IA.