People managing myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) are at a higher risk of developing an invasive fungal infection, which is a severe, systemic infection that occurs when yeasts or molds invade deep-seated body tissues.
Over half of all invasive fungal infections in blood cancer patients occur during or immediately following initial intensive treatments, such as induction chemotherapy.
Because these infections can become life-threatening and further weaken the immune system, knowing early warning signs and staying in close communication with your care team are essential steps in protecting your health.
What are the risk factors for developing an invasive fungal infection?
Both blood cancer itself and the treatments used to manage it can significantly weaken the body's natural defenses. Key risk factors include:
Treatment with hypomethylating agents (HMAs): Therapies like azacitidine (AZA) or decitabine (DAC) reprogram abnormal cells, but they can also suppress healthy immune function.
Neutropenia: Having abnormally low levels of neutrophils, the primary white blood cells that fight off fungal and bacterial invaders, leaves the body vulnerable to opportunistic organisms.
Central venous catheters: Having a port or central line provides necessary access for medications and blood draws, but it can also act as an entry point for environmental yeast or mold.
Overall immune suppression: High-dose chemotherapy, stem cell transplant conditioning, or prolonged steroid use further impair immune defenses.
Common types of invasive fungal infections
Fungal organisms exist naturally in the environment and on human skin, but they become dangerous when the immune system cannot keep them in check. The most frequent types include:
Fungal pneumonia: Infection of the lung tissue accounts for approximately 40% of all IFIs in blood cancer patients.
Invasive candidiasis: Caused by Candida yeast species, this is the most common cause of systemic fungal infections worldwide, often entering through central lines or the digestive tract into the bloodstream.
Aspergillosis: Caused by inhaling microscopic Aspergillus mold spores found in air, dust, or soil, this mold primarily attacks the lungs and sinuses.
Endemic fungal molds: Organisms such as Histoplasma, Blastomyces, or Coccidioides (Valley Fever) can cause severe respiratory and systemic infections depending on your geographic region and exposure.
What are the symptoms of fungal infections?
Because invasive fungal infections can spread quickly to other body systems, achieving an early and accurate diagnosis is critical. Contact your oncology care team immediately if you experience any of the following symptoms:
Unexplained or persistent fever: A fever during neutropenia is a medical emergency that requires prompt evaluation.
Respiratory symptoms: Shortness of breath, persistent cough, coughing up blood, nasal congestion, or sinus pain.
Skin changes: New skin lesions, unusual sores, nodules, or reddened areas.
General symptoms: Severe fatigue, chills, unexplained muscle aches, or chest pain when breathing.
How to prevent invasive fungal infections?
Managing invasive fungal infections requires an individualized, proactive approach tailored to your specific blood count levels and treatment phase:
Preventive medications: Even if you show no signs of infection, your doctor may prescribe targeted antifungal medications, such as posaconazole, voriconazole, fluconazole, or itraconazole, during periods of low white blood cell counts to prevent fungi from taking hold.
Diagnostic imaging and lab tests: If an infection is suspected, doctors use specialized blood tests (such as fungal antigen markers), CT scans of the chest or sinuses, or tissue biopsies to identify the exact organism and start targeted therapy right away.
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As an MDS or AML patient, staying informed and keeping track of your health metrics empowers you to make confident decisions alongside your care team.
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