Cancer Patients and Fungal Infections

As a cancer patient, you may have received a lot of information about your treatment and your journey to recovery. Chemotherapy and radiation cause many changes in the body as they destroy cancer cells. One major change is that these treatments weaken your immune system, which can increase your chances of getting an infection, including a fungal infection.

Stem cell transplant patients or those who have a blood (hematologic) cancer such as leukemia, lymphoma, or myeloma may have different risks for fungal infections. Please see Stem Cell Transplant Patients and Fungal Infections for more information.

What you need to know about fungal infections

Chemotherapy and radiation lower your white blood cell count. As you receive your cancer treatment, your white blood cell count can become very low, also known as neutropenia  [PDF - 2 pages].  During this time, your body will have trouble fighting infections, including fungal infections.1

Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can be deadly, like fungal pneumonia. Because of this, it’s important to seek treatment as soon as possible to try to avoid serious infection.

Fungal infections can look like bacterial or viral infections. If you’re taking medicine to fight an infection and you aren’t getting better, ask your doctor about testing you for a fungal infection.

The type of cancer you have can affect your risk. If you have a blood cancer like leukemia or myeloma, you may be at greater risk for getting a fungal infection than people with other types of cancer.2,3

Your risk of infection can change based on the strength of your chemotherapy. Some types of cancer may require stronger chemotherapy medication than others, especially the blood cancers. This is sometimes known as aggressive chemotherapy. Aggressive chemotherapy weakens your immune system and can put you at risk for getting a fungal infection.4

Your hospital stay matters. After your transplant, you may need to stay in the hospital for a long time. While there, you may need to have procedures that can increase your chance of getting a fungal infection. Please see types of hospital-associated infections for more information.

Where you live (geography) matters. Some disease-causing fungi are more common in certain parts of the world. If you live in or visit these areas and have cancer, you may be more likely to get these infections than the general population.5 For more information on travel-related illnesses, please see the CDC Traveler’s Health site.

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Preventing fungal infections in cancer patients

Fungi are difficult to avoid because they are a natural part of the environment. Fungi live outdoors in soil, on plants, trees, and other vegetation. They are also on many indoor surfaces and on your skin. However, there may be some ways for you to lower the chances of getting an infection, including a serious fungal infection.

Learn about fungal infections. There are different types of fungal infections. Learning about them can help you and your healthcare provider recognize the symptoms early, which may prevent serious illness.

Know if your white blood cell count is low. Having a very low white blood cell count (neutropenia  [PDF - 2 pages]) can put you at greater risk of infection.6

Get additional medical care if necessary. Fungal infections often resemble other illnesses. Visiting your healthcare provider may help with faster diagnosis and may prevent serious illness.

Antifungal medication. Your healthcare provider may prescribe medication to prevent fungal infections. Scientists are still learning about which patients are at highest risk and how to best prevent fungal infections.6,7

Protect yourself from the environment. As you recover from chemotherapy and start doing your normal activities again, there may be some ways to lower the chances of getting a serious fungal infection by trying to avoid disease-causing fungi in the environment.8 It’s important to note that although these actions are recommended, they have not been proven to prevent fungal infections.

• Try to avoid areas with a lot of dust like construction or excavation sites.
• Stay inside during dust storms.
• Stay away from areas with bird and bat droppings. This includes places like chicken coops and caves.
• Wear gloves when handling materials such as soil, moss, or manure.
• Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas.

Click here to read more about preventing infections in cancer patients.

References

1. Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia. Cancer 2004;100:228-37.
2. Bodey G, Bueltmann B, Duguid W, et al. Fungal infections in cancer patients: an international autopsy survey. European Journal of Clinical Microbiology & Infectious Diseases 1992;11:99-109.
3. Pagano L, Akova M, Dimopoulos G, Herbrecht R, Drgona L, Blijlevens N. Risk assessment and prognostic factors for mould-related diseases in immunocompromised patients. Journal of Antimicrobial Chemotherapy 2011;66:i5-i14.
4. Ribaud P. Fungal infections and the cancer patient. European Journal of Cancer 1997;33, Supplement 4:S50-S4.
5. Lortholary O, Charlier C, Lebeaux D, Lecuit M, Consigny PH. Fungal infections in immunocompromised travelers. Clinical Infectious Diseases 2013;56:861-9.
6. Böhme A, Ruhnke M, Buchheidt D, et al. Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Annals of Hematology 2009;88:97-110.
7. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2011;52:e56-e93.
8. CDC. Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients. MMWR: Recommendations and Reports 2000;49:1-128.