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Only for Public Consultation. Not for Other Distribution 1 Global guideline for the diagnosis and management of invasive infections caused by emerging, 2 uncommon or rare yeasts: An initiative of the European Confederation of Medical Mycology in 3 cooperation with TBD 4 5 Sharon C-A Chen*, John Perfect*, Arnaldo L. Colombo*, Oliver A. Cornely*, Andreas H. Groll, 6 Danila Seidel, Kerstin Albus, Joao N. de Almedia Jr., Guilliermo Garcia-Effron, Nicole Gilroy, 7 Cornelia Lass-Florl, Luis Ostrosky-Zeichner, Livio Pagano, Tamas Papp, Riina Rautemaa- 8 Richardson, Jon Salmanton-Garcia, Andrej Spec, Jorg Steinmann, Sevtap Arikan-Akdagli, 9 Dorothee E. Arenz, Rosanne Sprute, Luisa Duran-Graeff, Tomas Freiberger, Corrado Girmenia, 10 Michelle Harris Souha Kanj, Olivier Lortholary, Joseph Meletiadis, Maryam Roudbary, Esther 11 Segal, Felipe Tuon, Nathan Wiederhold, Tihana Bicanic, Jagdish Chander, Yee-chun Chen, Po-ren 12 Hsueh, Margaret Ip, Patricia Munoz, Isabel Spriet, Elivs Temfack, Luis Thompson, Aristea 13 Velegraki, Nelesh P. Govender* 14 *Equal contribution consultation. 15 16 Affiliations distribution. 17 SC-AC: Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical 18 Pathology and Medical Research,public New South Wales Health Pathology, and Centre for Infectious 19 Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, Australia 20 JP: Duke University Medicalfor Center, Durham,other North Carolina, USA 21 ALC: Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de Sao 22 Paulo, Sao Paulo, Brazil for 23 OAC:Only Department I of Internal Medicine University Hospital of Cologne, German Centre for 24 Infection ResearchNot (DZIF) partner site-Bonn-Cologne, ECMM Excellence Centre, Clinical Trials 25 Centre Cologne, University Hospital of Cologne, CECAD Cluster of Excellence, University of 26 Cologne, Cologne, Germany 27 AHG: Infectious Disease Research Program, Centre for Bone Marrow Transplantation and 28 Department of Paediatric Hematology and Oncology, University Children's Hospital Muenster, 29 Muenster, Germany 1 30 DS: Department of Internal Medicine University Hospital of Cologne, ECMM Excellence Centre, 31 CECAD Cluster of Excellence, University of Cologne, Cologne, Germany 32 KA: Department of Internal Medicine University Hospital of Cologne, ECMM Excellence Centre, 33 CECAD Cluster of Excellence, University of Cologne, Cologne, Germany 34 JNAJ: Central Laboratory Division, Hospital das Clínicas da Faculdade de Medicina da 35 Universidade de São Paulo, São Paulo, Brazil; Center for Discovery and Innovation, Hackensack 36 Meridian Health, Nutley, New Jersey, USA 37 GGE: Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, 38 Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, 39 Argentina and Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), CCT 40 Santa Fe, Argentina 41 NG: Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of 42 Sydney, Sydney, Australia 43 CL-F: Institute of Hygiene and Medical Microbiology,consultation. ECMM Excellence Centre, Medical 44 University of Innsbruck, Innsbruck, Austria 45 LO-Z: Division of Infectious Diseases, McGovern Medical School,distribution. Houston, Texas, USA 46 LP: Fondazione Policlinico Universitario A. Gemelli – IRCCS, Università Cattolica del Sacro Cuore, 47 Largo Agostino Gemelli 8, I-00168public Roma, Italy 48 TP: Fungal Pathogenicity Mechanisms Researchother Group, Department of Microbiology, University 49 of Szeged, Szeged, Hungaryfor 50 RR-R: Manchester University NHSfor Foundation Trust, Wythenshawe Hospital, ECMM Excellence 51 Centre and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, 52 MedicineOnly and Health, University of Manchester, UK 53 JS-G: Department Notof Internal Medicine University Hospital of Cologne, ECMM Excellence Centre, 54 CECAD Cluster of Excellence, University of Cologne, Cologne, Germany 55 AS: Division of Infectious Disease, Washington University in St Louis, School of Medicine, St. Louis, 56 Missouri, USA 2 57 JS: Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical 58 University, Nuremberg, Germany; Institute of Medical Microbiology, University Hospital Essen, 59 Essen, Germany 60 SA-A: Department of Medical Microbiology, Hacettpe University Medical School, Sihhiye Ankara, 61 Turkey 62 DEA: Department of Internal Medicine University Hospital of Cologne, German Centre for 63 Infection research (DZIF) partner site-Bonn-Cologne, ECMM Excellence Centre, University 64 Hospital of Cologne, Cologne, Germany; MediGate, Medical Center Hamburg-Eppendorf (UKE), 65 Hamburg, Germany 66 RS: Department of Internal Medicine University Hospital of Cologne, German Centre for Infection 67 research (DZIF) partner site-Bonn-Cologne, ECMM Excellence Centre, University Hospital of 68 Cologne, Cologne, Germany 69 LD-G: Unidad de Infectología, Departamento de Medicina Interna, Clínica Las Condes, Santiago, 70 Chile consultation. 71 TF: Centre for Cardiovascular Surgery and Transplantation, Brno, and Medical Faculty, Masaryk 72 University, Brno, Czech Republic distribution. 73 CG: Department of Hematology, Umberto I Policlinico di Roma, Roma, Italy 74 MH: Duke University Medical Center,public Durham, North Carolina, USA 75 SK: Department of Internal Medicine, Divisionother of Infectious Diseases, American University of 76 Beirut Medical Centre,for Beirut, Lebanon 77 OL: Service des Maladies Infectieusesfor et Tropicales, Hôpital Necker-Enfants malades, Université 78 Paris V, Paris, France 79 JM: ClinicalOnly Microbiology Laboratory, Attikon University Hospital, Medical School, National and 80 Kapodistrian UniversityNot of Athens, Athens, Greece 81 MR: Department of Mycology and Parasitology, School of Medicine, University of Medical 82 Science, Tehran, Iran 83 ES: Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv 84 University, Tel Aviv, Israel 3 85 FT: Laboratory of Emerging Infectious Diseases (LEID), Pontifícia Universidade Católica do Paraná, 86 Curitiba, PR, Brazil 87 NW: Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, Texas, 88 USA 89 TB: Insitute of Infection and Immunity, St George’s Univiersty of London, England, United 90 Kingdom 91 JC: Department of Microbiology, Government Medical College Hospital, Chandigarh, India 92 Y-CC: Division of Infectious Diseases, Department of Medicine, Centre for Infection Control, 93 National Taiwan University, College of Medicine, Taipeh, Taiwan 94 P-RH: Department of Laboratory Medicine, and the Department of Internal Medicine, National 95 Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan 96 MI: Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong, China 97 PM: Infectious Diseases and Clinical Microbiology Department,consultation. Hospital General Universitario 98 Gregorio Marañón, Servicio de Microbiología-Enfermedades Infecciosas, Madrid, Spain 99 IS: Department of Pharmaceutical and Pharmacological Sciences,distribution. KU Leuven, Leuven, Belgium 100 and Pharmacy Department, University Hospitals Leuven, Leuven, Belgium 101 ET:Internal Medicine Unit, Doualapublic General Hospital, Douala, Cameroon 102 LT: Unidad de Infectologia, Departamento de Medicina, Clinica Alemana-Universidad del 103 Desarrollo, Santiago, forChile other 104 AV: Mycology Research Laboratory and UOA/HCPF Culture Collection, Depatment of 105 Microbiology, Medical School, Nationalfor and Kapodistrian University of Athens, Athens, Greece 106 NPG:Only National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, 107 Antimicrobial ResistanceNot and Mycoses), a Division of the National Health Laboratory Service and 108 School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 109 South Africa 4 110 ABSTRACT 111 In these guidelines we examined the epidemiology, diagnosis and management of uncommon, 112 emerging or rare yeast infections excluding those caused by any Candida and Cryptococcus 113 species. It is important to emphasize several points. First, the selection of rare yeasts is arbitrary 114 and does not cover them all but includes the most common clinically encountered genera. 115 Second, by definition, there is reduced clinical experience of rare yeast infections and studies on 116 these diseases were not randomized nor were groups compared. Therefore, most 117 recommendations are not robust in their validations but simply represent insightful guidance 118 using clinical cases/reviews, expert clinician opinions, and in vitro susceptibility testing. Third, 119 these rare yeasts are dynamic in their nomenclature as molecular studies continue to be applied 120 to changing taxonomy. Therefore, the connection with the named genera/species and outcomes 121 can be difficult to follow. Finally, although these yeast infections are uncommon, they are 122 continuing to increase particularly in advanced health care systems with a growing 123 immunocompromised population. It is with these contexts considered that we examined the 124 genera of Trichooporon, Malassezia, Sporobolomyces,consultation. Rhodotorula, Pseudozyma (renamed 125 Moesziomyces), Saccharomyces, Saprochaete, Kodamaea and Geotrichum. In these guidelines, 126 we comprehensively report their epidemiology, microbiology,distribution. detection methods for these
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