2046: Fungal Infection Pre-Infusion Data

Fungal infections are significant opportunistic infections affecting transplant patients. Because these infections are quite serious, it is important to collect additional information on them. The Fungal Infection Pre-Infusion Data (2046) Form captures information regarding the diagnosis, treatment, and response to treatment of any proven or suspected fungal infections diagnosed prior to receiving a HCT or cellular therapy. This form must be completed when one of the fungal infections listed below has been reported on the Recipient Baseline (2000) Form. One form will be completed for each applicable infection reported.

The following infections will cause a Fungal Infection Pre-Infusion Data (2046) Form to come due when reported on the Recipient Baseline (2000) Form:

• Aspergillus flavus
• Aspergillus fumigatus
• Aspergillus niger
• Aspergillus, NOS
• Aspergillus terreus
• Aspergillus ustus
• Blastomyces (dermatitidis)
• Candida albicans
• Candida non-albicans
• Cryptococcus gattii
• Cryptococcus neoformans
• Fusarium (all species)
• Histoplamsa (capsulatum)
• Mucorales (all species)
• Rhizopus (all species)
• Scedosporium (all species)
• Zygomycetes, NOS
• Suspected fungal infection
  

For reference, definitions of some common terms concerning fungal infections are provided below. These definitions are for clarification only and should not be considered to be reporting criteria or instructions.

• Fungemia: The presence of fungus (mold or yeasts) in blood cultures
• Proven invasive fungal infections: Based on EORTC published recommendations as follows¹:
  • Histopathologic, cytopathologic, or direct microscopic examination of a specimen obtained by needle aspiration or biopsy in which hyphae or melanized yeast-like forms are seen accompanied by evidence of associated tissue damage (molds) or showing encapsulated budding yeasts or Candida species showing pseudohyphae or true hyphae (yeasts); or
  • Cultures of specimens obtained by a sterile procedure from a normally sterile site (excludes bronchial lavage, sinus specimen, and urine) with clinical or radiologic evidence of abnormal growing mold, ‘black yeast’, or yeast.
• Probable invasive fungal infections: Based on EORTC published recommendations1 requires presence of one each of host factors, clinical features, and mycological features:

Host Factors

• Receipt of allogeneic HCT
• Treatment with steroids of at least 0.3mg/kg/day prednisone equivalent for three weeks or longer
• Treatment with T-cell immunosuppressants (cyclosporine, tacrolimus), monoclonal antibodies (alemtuzumab), or nucleoside analogues (fludarabine) in the past 90 days
  

Clinical Features

• Lower respiratory tract disease includes CT findings of one of the following:
  • Dense, well-circumscribed lesions with or without a halo
  • Air-crescent sign
  • Cavity
• Tracheobronchitis with evidence of ulceration, nodule, pseudomembrane, plaque, or eschar on bronchoscopy
• Sinonasal infection with; CT documenting acute sinusitis and at least one of the following:
  • Acute localized pain (including radiation to the eye)
  • Nasal ulceration with black eschar
  • Bone destruction of the sinuses.

Mycological Features

• Direct: Fungal elements of mold or culture of specific mold from sputum, bronchoalveolar lavage, bronchial brushings, or sinus aspirate.
• Indirect: Galactomannan antigen detected in serum, plasma, bronchial lavage fluid, or cerebrospinal fluid or Beta-D-glucan detected in serum.
  

Disseminated infections with Histoplasmosis, Blastomycosis, or Coccidiomycosis:

• Culture of any of these organisms from an affected site or from the blood
• Histopathology or direct microscopic demonstration of the appearance characteristic of these dimorphic (can exists in both a yeast and mold (hyphae) form based on external conditions) fungi
• Demonstration of coccidioidal antibody in CSF or a 2-dilution rise in two consecutive blood samples in the appropriate setting; or
• Presence of a host factor (see above) plus an appropriate clinical picture with mycological evidence such as a positive Histoplasma antigen test from urine, blood, or cerebrospinal fluid
  

Disseminated Cryoptococcus: Crypotococcal antigen detected in the cerebrospinal fluid.

¹ Clin Infect Dis. 2008 June 15; 46(12): 1813–1821

Links to Form Sections
Q1 – 25: Infection Episode
Q26 – 31: Treatment of Infection

Manual Updates
Sections of the Forms Instruction Manual are frequently updated. The most recent updates for the current manual version can be found below. For additional information, select the manual section and review the updated text.

To review the historical Manual Change History for this manual, reference the retired manual section on the Retired Forms Manuals webpage.

Date	Manual Section	Add/Remove/Modify	Description
2/20/2026	2046: Fungal Infection Pre-Infusion Data	Modify	Version 3 of the 2046: Fungal Infection Pre-Infusion Data section of the Forms Instructions Manual released. Version 3 corresponds to revision 6 of the Form 2046.

Copyright © 2004-2025 The Medical College of Wisconsin, Inc. and NMDP. All Rights Reserved.
CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.