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Immunity and infection prevention

Fungal infections

The main article (“Fungal infections”) explains fungi in general. This topic looks more deeply at who gets fungal infections in leukaemia, when and how, and how they are found and prevented.

Last updated: ~1 min read
Spores in a beam of light.
Figure 1.Mould spores float in the air.

01Short answer

Fungal infections usually happen during long, deep neutropenia, after high-dose steroids and after a transplant. There are two main groups: yeasts (Candida), which cause white patches in the mouth and sometimes reach the blood; and moulds (Aspergillus and others), whose spores are in the air, are breathed in and cause lung infection. A fever that persists despite antibiotics can point to a fungal infection. Diagnosis uses CT scans, blood tests (galactomannan, beta-D-glucan) and sometimes bronchoscopy. Antifungal prevention may be given to people at high risk.

02Simple explanation

Yeasts: mouth and blood.

Moulds: through the air into the lungs.

Long neutropenia: the main risk.

03Scientific explanation

Biomarkers: galactomannan and beta-D-glucan blood tests raise suspicion of fungal infection but do not make the diagnosis alone.

Prevention: in high-risk settings such as AML induction and allogeneic transplant, antifungal prevention is widely used.

04What happens in the body?

Spores in the air

Mould spores are plentiful in building dust and soil.

Yeast in the mouth

White patches in the mouth may be Candida; show your doctor.

White patches on the mouth lining.
Figure 2.Yeast patches in the mouth.

A lung scan

Small spots on CT can be an early sign of mould infection.

A lung with a halo-shaped spot.
Figure 3.A small spot in the lung.

05How a fungal infection develops

Four steps.

Spore — A spore in the air.1SporeA spore in the air.
Long risk — Neutropenia drags on.2Long riskNeutropenia drags on.
Search — Scans and tests.3SearchScans and tests.
Protection — Antifungals and care.4ProtectionAntifungals and care.

06Yeasts and moulds

Yeasts (Candida)Moulds (Aspergillus)
SourceOur own floraAir, soil, building work
Typical siteMouth, gullet, bloodLungs, sinuses
SignsWhite patches, painful swallowingFever, cough, chest pain
How foundExamination, cultureCT, galactomannan

07Key terms

Yeast
A single-celled fungus (such as Candida).
Mould
A fungus that spreads by spores (such as Aspergillus).
Antifungal
A medicine against fungi.
Galactomannan
A blood test for Aspergillus.
Spore
A tiny reproductive particle of a fungus.

08Key points

  • Fungi are dangerous in long neutropenia.
  • Yeasts and moulds differ.
  • A persistent fever can be a signal.
  • CT and blood tests help.
  • Prevention is often given.
  • Avoid building sites and soil.

09Frequently asked questions

What if there is mould at home?

Ask someone else to clean it and tell your doctor (“Home, hospital and surroundings”).

Can I garden?

Do not work with soil during neutropenia (“Animals, plants and soil”).

How long will I take antifungals?

It depends on your risk; your team will tell you.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. What if there is mould at home?

  2. Can I garden?

  3. How long will I take antifungals?

My questions

12Sources

  1. MedlinePlus (U.S. National Library of Medicine). Fungal Infections
  2. National Cancer Institute (NCI). Infection and Neutropenia during Cancer Treatment
  3. American Cancer Society. Infections in People with Cancer
  4. Centers for Disease Control and Prevention (CDC). Hand Sanitizer Guidelines and Recommendations
  5. MedlinePlus (U.S. National Library of Medicine). Pets and the immunocompromised person
  6. Centers for Disease Control and Prevention (CDC). Foods That Can Cause Food Poisoning
  7. BMJ Supportive & Palliative Care, 2019. Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis
  8. Journal of Clinical Oncology (ASCO), 2024. Vaccination of Adults With Cancer: ASCO Guideline
  9. The Lancet Infectious Diseases (ECIL 7), 2019. Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7)
  10. Biology of Blood and Marrow Transplantation, 2009. Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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