Clinical guidelines for fungal infections

* * * Last updated: October 2024 * * *

The documents linked below provide the most up-to-date recommendations compiled by committees of experts, based on scientific literature and research. Where no guidelines exist for a particular disease, comprehensive reviews are included which contain expert recommendations.

Country or region of publication is listed in square brackets.

Invasive infections

Infection or purpose	Guidelines
Diagnosis	8th European Conference on Infections in Leukaemia (Groll et al, 2021) Guidelines for the diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or post-haematopoietic cell transplantation [Europe] BSMM (Schelenz et al, 2015) Diagnosis of serious fungal diseases [UK] ISHLT (Husain et al, 2015) Management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients [International] Diagnosing dermatomycoses in a clinical mycology laboratory: guidelines proposed by the Czech Society for Medical Microbiology Working Group on Mycology [Europe] South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors (Bansal et al, Sept 2023) [Asia] AWMF Guideline for the Medical Clinical Diagnostics of Indoor Mould Exposure (Wiesmüller et al, 2017) [Europe]
Prophylaxis	Annals of Hematology (Christopeit et al, 2021) Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation – update of the recommendations of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. [Germany] RACP (Fleming et al, 2014) Prophylaxis in haematological malignancy and HSCT [Australasia]
General	ECIL-6 (Tissot et al, 2017) Invasive candidiasis, aspergillosis and mucormycosis in leukaemia/HSCT [Europe] Clinical Practice Guideline for the Therapeutic Drug Monitoring of Voriconazole in Non-Asian and Asian Adult Patients: Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring (Takesue et al, 2022) [Asia] SWAB practice guide (2017) Invasive fungal infections [Netherlands] IDST (Ko et al, 2016) Antifungal agents in patients with hematological malignancies or HSCT [Taiwan] CIFIWG (2020, 6th edition) Diagnosis and treatment of invasive fungal disease in patients with hematological disorders and cancers [China 中国] Morgan et al (2016) Critical review of current clinical practice guidelines for antifungal therapy in paediatric haematology and oncology Introduction to RACP guidelines (Slavin et al, 2014) [Australasia] – (Blyth et al, 2014) Invasive mould infections in haematological malignancy and HSCT – (Chen et al, 2014) Yeast infections in the haematology, oncology and intensive care setting – (Morrissey et al, 2014) Empiric and diagnostic‐driven antifungal treatment strategies in haematological malignancy – (Chau et al, 2014) Optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy – (Chang et al, 2014) Prevention and surveillance during hospital building works Mycoses (Ruhnke et al, 2020) Treatment of invasive fungal diseases in cancer patients – Revised 2019 – Recommendations of the Infectious Diseases Working Party of the German Society of Hematology and Oncology. [Germany] Journal of Clinical Oncology (Lehrnbecher et al, 2020) Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients. [International] Guideline for the Management of Fever and Neutropenia in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update (Lehrnbecher et al, 2023) [International] The Lancet (Hoenigl et al, 2021) 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. [Australasia] Stemler et all (2022) Antifungal prophylaxis in adult patients with acute myeloid leukaemia treated with novel targeted therapies: a systematic review and expert consensus recommendation from the European Hematology Association [Europe] Zhonghua Er Ke Za Zhi. Expert consensus on clinical practice of invasive pulmonary fungal infections in children (2022) [China] Zhonghua Xue Ye Xue Za Zhi. Chinese expert consensus for invasive fungal disease in patients after hematopoietic stem cell transplantation (2023) [China]
Cryptococcosis	JSMM (Izumikawa et al, 2019) Diagnosis and Treatment of Cryptococcosis [Japan] IDSA (Perfect et al, 2010) Management of Cryptococcal Disease [USA] WHO (2018) Diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children [International] Clinicalinfo.HIV.gov (2021) Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV [USA] SAHCS (Govender et al, 2013) Prevention, diagnosis and management of cryptococcal meningitis among HIV-infected persons [Southern Africa] RACP (Chen et al, 2014) Yeast infections in the haematology, oncology and intensive care setting [Australasia]
Histoplasmosis	IDSA (Wheat et al, 2007) Management of patients with Histoplasmosis [USA] Clinicalinfo.HIV.gov (2015) Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV [USA] Pan American Health Organization (2020) Diagnosing and managing disseminated histoplasmosis among people living with AIDS [Global]
Aspergillosis & Mucormycosis	IDSA (Patterson et al, 2016) Diagnosis and Management of Aspergillosis [USA] Expert panel (Al-Abdely et al, 2013) Treatment of invasive Aspergillus infections in adults [Middle East] ESCMID-ECMM-ERS (Ullman et al, 2018) Diagnosis and management of Aspergillus diseases [Europe] ECIL-6 (Tissot et al, 2017) Invasive candidiasis, aspergillosis and mucormycosis in leukaemia/HSCT[Europe] AST-IDCOP (Husain et al, 2019) Invasive Aspergillosis in solid‐organ transplant recipients [USA] Case series (Giudice et al, 2016) Rhinocerebr al mucormycosis [Italy] SWAB (2017) Netherlands * * The SWAB guidelines are different from other invasive aspergillosis guidelines as they are the first for: – ICU and severe influenza and IA – Initial therapy for those areas with a high azole resistance frequency in A. fumigatus The Lancet (Cornely et al, 2019) Global guideline for the diagnosis and management of mucormycosis. [Global] Transplantation and Cellular Therapy (Dadwal et al, 2021) Management and Prevention of Aspergillosis in Hematopoietic Cell Transplantation Recipients. [North America] (Garcia-Vidal et al, 2019) Executive summary of clinical practice guideline for the management of invasive diseases caused by Aspergillus: 2018 Update by the GEMICOMED-SEIMC/REIPI [Europe] (Zhonghua Jie He He Hu Xi Za Zhi, 2024) Expert consensus on diagnosis and treatment of severe COVID-19 associated pulmonary aspergillosis and mucormycosis [China] Columbian consensus for prophylaxis, treatment & prevention of IA in adults and pediatric patients (2022) [South America]
Fungal rhinosinusitis	ERS/EAACI (Fokkens et al, 2012) Position Paper on Rhinosinusitis and Nasal Polyps [Europe]
Phaeohyphomycosis (black moulds)	ESCMID/ECMM (Chowdary et al, 2014) Diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi [Europe]
Pneumocystis pneumonia (PCP/PJP)	RACP (Cooley et al, 2014) Diagnosis, prophylaxis and management of Pneumocystis jirovecii pneumonia in patients with haematological and solid malignancies [Australasia] ECIL (2016): prevention; diagnosis; treatment [Europe] ASTID (Fishman et al, 2019) PJP and solid organ transplants PJP prophylaxis for children with tumours [USA] The Kidney Disease Improving Global Outcome (2009). Kidney Disease: Improving Global Outcomes Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients [Global] Baker et al (2017) Renal association clinical practice guideline in post-operative care in the kidney transplant recipient [Global]

Invasive candidiasis

Infection	Guidelines	Commentary/literature
Invasive Candida infections	ESCMID (2012) Europe: – Guideline development – Diagnosis – Non-neutropenic adults – Prevention and treatment in neonates and children – Adults with haematological malignancies, or after HSCT – Haem-onc & ICU RACP (Chen et al, 2014) Yeast infections in the haematology, oncology and intensive care setting [Australasia] CDC (2020) C. auris prevention/control [USA] ECIL-6 (Tissot et al, 2017) Invasive candidiasis, aspergillosis and mucormycosis in leukaemia/HSCT [Europe] Expert panel (Alothman et al, 2014) Management of invasive Candida infections in adults [Middle East] International Medicine Journal (Ong et al, 2019) Diagnosis, management and prevention of Candida auris in hospitals: position statement of the Australasian Society for Infectious Diseases	Tagliaferri & Menichetti (2015) Treatment of invasive candidiasis: between guidelines and daily practice Ahmed et al (2015) Invasive candidiasis in non-neutropenic critically ill – need for region-specific management guidelines Tragiannidis et al (2014) Invasive candidiasis and candidaemia in neonates and children: update on current guidelines Candidaemia IDSA (Pappas et al, 2016) Management of candidiasis [USA] EPICO 4.0 (Zaragoza et al, 2017) ‘Total quality’ in the management of invasive candidiasis in critically ill patients [Spain] ESA (O’Leary et al, 2017) Management of Invasive Candidiasis and Candidemia in critically ill adults [Europe] SBI/SPI/SBMT (Colombo et al, 2013) Management of candidiasis [Brazil] LAIMN (Santolaya et al, 2013) Management of candidemia in children [Latin America] Mellinghoff et al (2018) Equal Candida Score Jack et al (2016) International guidelines: the need to standardize the management of candidaemia
Candida peritonitis	ISPD (Piraino et al, 2011) REDUCING THE RISKS OF PERITONEAL DIALYSIS–RELATED INFECTIONS [International] Jávea (Pemán et al, 2017) Candida peritonitis and other intra-abdominal fungal infections in non-neutropenic critically ill adult [Spain]	Montravers et al (2013) Intra-abdominal candidiasis: the guidelines-forgotten non-candidemic invasive candidiasis
Rare yeasts	ESCMID/ECMM (Arendrup et al, 2014) diagnosis and management of rare invasive yeast infections [Europe] Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM (Chen et al, 2021) [Global]

Mucosal candidiasis

Infection	Guidelines
In patients with HIV/AIDS	ESCMID (Lortholary et al, 2012) Diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS [Europe] Clinicalinfo.HIV.gov (2015) Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV [USA]
Oral	IDSA (Pappas et al, 2016) Management of candidiasis [USA] WHO (2014) Treatment of skin and oral HIV-associated conditions in children and adults [International]
Oesophageal	IDSA (Pappas et al, 2016) Management of candidiasis [USA]
Balanitis	Int J STD & AIDS (Edwards et al, 2013) management of balanoposthitis [Europe]
Vaginal	International Journal of STD and AIDS. (Saxon et al, 2019) British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis [UK] Mycoses (Farr et al, 2021) Guideline: vulvovaginal candidosis [Germany] Center for Disease Control. Vulvovaginal Candidiasis (2020) [USA]

Allergic fungal conditions

Condition	Guidelines
ABPA	IDSA (Patterson et al, 2016) Diagnosis and Management of Aspergillosis [USA] Jat et al (2018) Childhood ABPA [India] Evidence‑Based Guidelines for the Management of Allergic Bronchopulmonary Aspergillosis (ABPA) in Children and Adolescents with Asthma (Mathew et al, 2023) [International] Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses (Agarwal et al, 2024) [International]
SAFS	ERS/ATS (Chung et al, 2014) Definition, evaluation and treatment of severe asthma [Europe]
Rhinosinusitis	Singh et al (2017) Fungal Rhinosinusitis: Microbiological and Histopathological Perspective [India]
Thunderstorm asthma	HPA (Dabrera et al, 2017) Overview of the evidence base and implications for public health advice [UK] Alfred Health (2017) Prevention of thunderstorm asthma [Australia]

Chronic deep tissue & lung

Infection	Guidelines
Chronic pulmonary aspergillosis	ESCMID-ECMM-ERS (Ullman et al, 2018) Diagnosis and management of Aspergillus diseases [Europe] IDSA (Patterson et al, 2016) Diagnosis and Management of Aspergillosis [USA] Salzer et al (2016) Characterization of CPA patients according to new ESCMID/ERS/ECMM and IDSA guidelines Colombian consensus on the diagnosis and treatment of chronic, saprophytic and/or allergic syndromes associated with Aspergillus spp. in adult and pediatric patients (2022) [South America] Colombian consensus on the diagnosis and treatment of extrapulmonary aspergillosis in adult patients (2022) [South America]
COVID-19 associated pulmonary aspergillosis (CAPA)	Hashim et al (2021) Practice Guidelines for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis in an Intensive Care Setting
Chronic cavitary pulmonary histoplasmosis	IDSA (Wheat et al, 2007) Management of Patients with Histoplasmosis [USA]
Deep-seated mycosis	Domestic guideline (Kohno et al, 2014) Management of Deep-seated Mycosis [Japan]
Coccidioidomycosis	IDSA (Galgiani et al, 2016) Treatment of Coccidioidomycosis [USA] Clinicalinfo.HIV.gov (2015) Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV [USA]
Paracoccidioidomycosis	Universidade de São Paulo (Shikanai-Yasuda et al, 2017) Management of paracoccidioidomycosis [Brazil]
Fungal ball of the sinus	IDSA (2008) [USA] Yoon et al (2017) Retrospective of 538 cases, with recommendations [Korea]
Fungal keratitis	International (2009) [International] American Academy of Ophthalmology. Fungal Keratitis – Sub-Saharan Africa [Africa]

Skin, hair & nails

Infection	Guidelines
Tinea capitis	Journal of the German Society of Dermatology (Mayser et al, 2019) Guidelines: tinea capitis [German] WHO (2014) [international]
Tinea cruris	WHO (2014) [international] AAD (1996)
Tinea manuum	WHO (2014) [international] AAD (1996)
Tinea corporis (ringworm)
Seborrhoeic dermatitis	DSD (2015)
Pityriasis versicolor	AAD (1996)
Hyalohyphomycosis (Fusarium, Scedosporium)	ESCMID/ECMM (2014) diagnosis&management, [Europe]
Malassezia	DSD (2015) treatment [Denmark]
Onychomycosis	BAD (2014)

Endemic mycoses

Infection	Guidelines
General	Global guideline for the diagnosis and management of the endemic mycoses Thompson et al (2021) [Global]
Sporotrichosis	IDSA (2007) [USA] Rossow et al. Sporothrix brasiliensis guideline (2020) [South America]
Chromoblastomycosis	ESCMID (2014) [Europe]
Blastomycosis	IDSA (2008) [USA]
Onychomycosis	Seebacher et al (2004) [German]

Other

Other	Guidelines
Diagnostics	IDSA /ASM utilisation of microbiology laboratories (2018) [USA] ID point-of-care testing (2016)
Testing	CPIC (2016) voriconazole and CYP2C19 Clinical Testing Guidance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis in Patients With Community-Acquired Pneumonia for Primary and Urgent Care Providers (2024) [USA]
Professional skills	Writing SOPs in resource-poor settings (2016) in PLOS NTDs Competency guidelines for PHL professionals (2015) CDC MMWR [USA]
Implementing guidelines	Birgand et al (2015) REVIEW Overcoming the obstacles of implementing infection prevention and control guidelines
IRIS	IRIS (2015) [India]
TDM	BSMM (Ashbee et al, 2013) TDM of antifungals [UK] (Chau et al, 2014) Optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy [Australasia]