[Reappraisal of risk factors for invasive pulmonary fungal disease]

Invasive fungal disease (IFD) has historically been observed predominantly in neutropenic patients, particularly those with hematological malignancies or undergoing allogeneic hematopoietic stem cell transplantation. However, clinical practice has found that an increasing proportion of patients with IFD have underlying diseases such as chronic obstructive pulmonary disease, severe viral pneumonia, and diabetes mellitus, rather than neutropenia. These patients have significantly different risk factors and degrees of immunosuppression to neutropenic patients, which makes assessment more difficult and leads to changes in how fungal infections are diagnosed. Based on the newly published "Guidelines for the diagnosis and treatment of invasive pulmonary fungal diseases (2025 edition)", this article systematically elaborates on the risk factors and their changes of IFD diagnosis, including classification, grading, and assessment methods. It also emphasizes the differences between neutropenic patients and their possible mechanisms. The aim is to provide a reference for correctly understanding the clinical guidelines for the diagnosis and treatment of IFD.