Diagnosis of breakthrough fungal infections in the clinical mycology laboratory: An ecmm consensus statement

Jeffrey D. Jenks, Jean Pierre Gangneux, Ilan S. Schwartz, Ana Alastruey-Izquierdo, Katrien Lagrou, George R. Thompson, Cornelia Lass-Flörl, Martin Hoenigl*, Z. Adamski, S. Arikan Akdagli, V. Arsic-Arsenijevic, O. A. Cornely, N. Friberg, N. Gow, S. Hadina, P. Hamal, M. Juerna-Ellam, N. Klimko, L. Klingspor, F. LamothM. Mares, T. Matos, V. Ozenci, T. Papp, E. Roilides, R. Sabino, E. Segal, A. F. Talento, A. M. Tortorano, P. Verweij

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient outcomes. In this review, we provide consensus recommendations on behalf of the European Confederation for Medical Mycology (ECMM) for the diagnosis of bIFI caused by invasive yeasts, molds, and endemic mycoses, to guide diagnostic efforts in patients receiving antifungals and support the design of future clinical trials in the field of clinical mycology. The cornerstone of lab-based diagnosis of breakthrough infections for yeast and endemic mycoses remain conventional culture, to accurately identify the causative pathogen and allow for antifungal susceptibility testing. The impact of non-culture-based methods are not well-studied for the definite diagnosis of breakthrough invasive yeast infections. Non-culture-based methods have an important role for the diagnosis of breakthrough invasive mold infections, in particular invasive aspergillosis, and a combination of testing involving conventional culture, antigen-based assays, and PCR-based assays should be considered. Multiple diagnostic modalities, including histopathology, culture, antibody, and/or antigen tests and occasionally PCR-based assays may be required to diagnose breakthrough endemic mycoses. A need exists for diagnostic tests that are effective, simple, cheap, and rapid to enable the diagnosis of bIFI in patients taking antifungals.

Original languageEnglish
Article number216
Pages (from-to)1-19
Number of pages19
JournalJournal of Fungi
Issue number4
StatePublished - Dec 2020


FundersFunder number
Al-Jazeera Pharmaceuticals
Astellas Pharma US
Gilead Sciences
Meso Scale Diagnostics
Janssen Pharmaceuticals
Plant Sciences Institute, Iowa State University
Deutsche ForschungsgemeinschaftEXC 2030–390661388
Deutsche Forschungsgemeinschaft
Bundesministerium für Bildung und Forschung
Basilea Pharmaceutica


    • Breakthrough invasive fungal infections
    • Diagnostics
    • Endemic mycoses
    • Invasive candidiasis
    • Invasive mold infections


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