Project summary: This proposal which is entitled "Defining epidemiology, diagnosis, prevention and treatment of invasive fungal infections in the United States" is an ambitious and overarching proposal which covers a host of issues in the clinical mycology arena. This proposal represents a series of independent projects that will be initiated in sequential fashion throughout the course of this 5- year award. The Mycoses Study Group (MSG) with its central unit located at UAB in the division of infectious diseases will be administering this program. The proposal has 3 broad specific aims which address some of the most important current public health issues and challenges as it relates to fungal infections. In the first aim, we will develop and maintain reliable and innovative methods of national fungal surveillance while also assessing specific risk factors for acquiring these infections in the treatment and outcomes associated with these disorders. The second aim will address a huge gap in the management of invasive mycoses, specifically improving the utility and the scope of fungal diagnostics. We will explore this through reviewing the existing utilization of fungal diagnostics but also creating a specimen repository that is linked to specific patients with the purpose of developing new diagnostics. Finally, we will explore specific public health interventions which may serve to mitigate the significant impact of fungal infections both in the general population and in specific high-risk subgroups. To accomplish these ambitious goals obviously requires significant coordination of efforts among a broad range of investigators, clinical centers, laboratories, and the CDC. The Mycoses Study Group is uniquely positioned to coordinate these efforts given his extensive history of designing coordinating and implementing both clinical and epidemiologic trials in mycology since 1978. We believe that at the completion of this award we will have moved much closer to understanding of current epidemiology of fungal infections in the United States will also have a much clearer picture of those who are at particularly high risk of developing severe complications from these infections. Moreover, we believe that we will have made significant strides towards improved deployment of existing fungal diagnostics and significant progress towards the development of new diagnostics. Finally, we will improve outcomes through increased public awareness and specific and strategic interventions which target individuals at highest risk and who may realize the greatest benefit from preventative strategies.