People with acute myeloid leukemia (AML) have an increased risk of fungal infections, which can be extremely serious if they spread to other parts of the body. Doctors may sometimes advise people with AML to take antifungal medications.

AML is a cancer of the blood and bone marrow. It affects the immune system, putting a person at higher risk of developing infections.

The two main microbes that can cause an AML fungal infection are Candida and Aspergillus, both of which can spread throughout the body.

This article discusses the link between AML and fungal infections. It also considers the risk factors, preventive measures, and treatment options.

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People with AML have a higher likelihood of contracting infections, including fungal ones. This increased risk stems from how AML affects immunity.

The American Cancer Society explains that leukemia cells replace healthy blood-making cells in the bone marrow. As a result, the body may produce low numbers of white blood cells.

According to the Centers for Disease Control and Prevention (CDC), people undergoing chemotherapy for any cancer have a risk of contracting all types of infections. The reason is that chemotherapy reduces the numbers of white blood cells, which play an important role in immunity. A person with fewer white blood cells is less able to fight infections.

People receiving treatment for AML have reduced numbers of white blood cells from both chemotherapy and the disease itself. Therefore, they are particularly at risk of infections, including fungal infections.

Learn more about white blood cells here.

Some fungal infections that affect a person with decreased immunity are mild and only cause a rash. Others may become invasive, which means that they spread to other parts of the body. Invasive infections can lead to serious conditions, such as pneumonia.

Invasive fungal infections are one of the leading causes of illness and death in individuals with acute leukemia. The two types of fungi that most commonly affect them are Candida and Aspergillus.


Candida naturally lives in the following places on the body:

  • skin
  • mouth
  • throat
  • gut
  • vagina

This fungus does not cause symptoms unless it grows so much that it becomes out of control.

A Candida infection may start in the vagina and produce symptoms, such as pain and abnormal discharge. Alternatively, it may affect the mouth and throat. Doctors generally only consider the infection serious when it spreads to other areas of the body, such as the brain, blood, and heart.

The most common symptoms of an invasive Candida infection are chills and fever that do not get better after antibiotic treatment.

Learn more about Candida infections here.


People contract an Aspergillus infection when they breathe in spores from the fungus, which is a common type of mold that can live both indoors and outdoors.

An infection may produce an allergic reaction similar to asthma and cause symptoms such as wheezing, coughing, and shortness of breath.

Symptoms of an invasive Aspergillus infection include:

If the fungus spreads from the lungs to other parts of the body, it can produce additional symptoms.

See pictures of various skin infections here.

The CDC states that the following factors may put a person with cancer at a higher risk of developing fungal infections:

  • taking stronger, or more aggressive, chemotherapy drugs
  • staying in the hospital a long time — for example, due to undergoing a stem cell transplant
  • living in a geographical area where fungi are more prevalent

As fungi are a natural part of a person’s environment, they are hard to avoid.

However, the CDC recommends that people help prevent an infection by:

  • learning about fungal infections, which may help them recognize the symptoms and get treatment early
  • visiting a doctor regularly, which may lead to a quicker diagnosis
  • taking antifungal medications when a doctor prescribes them

The CDC also suggests taking the following steps to prevent exposure to fungi in the environment:

  • avoiding areas with lots of dust, such as construction sites
  • wearing gloves when handling soil or manure
  • staying away from places with bird and bat droppings, such as caves or chicken coops
  • staying indoors during dust storms
  • wearing shoes, long pants, and shirts with long sleeves when working outdoors

Learn more about fungi-related hazards here.

Doctors use medications for prevention, as well as for treatment once a fungal infection develops.

Medications for prevention

A 2019 study reported that the incidence of invasive fungal infections in people with AML ranges from 12% to 24%. For this reason, the authors recommend that individuals with AML take antifungal medications even before they receive a diagnosis of an infection.

This type of strategy, which prevents rather than treats disease, is called prophylaxis. The study authors recommend taking such medications for as long as the white blood cell count remains low.

Medication options include:

Not all doctors believe that a person with AML should take antifungal drugs for prevention. A 2016 review found that some doctors advise prevention through early diagnosis and treatment instead.

The authors concluded that both prevention strategies had advantages and disadvantages.

One of the disadvantages of taking preventive medication involves the possible side effects of the medications that some individuals cannot tolerate.

Medications for treatment

For an invasive Candida infection, the type and dosage of medications depend on various factors, such as a person’s age and the severity of the illness.

The initial treatment involves medication belonging to the class of antifungal drugs called echinocandins, which doctors deliver through the vein. Other antifungal drugs may also be necessary for some individuals.

To treat an invasive Aspergillus infection, the CDC recommends several antifungal medications depending on the type of infection. These include some of the preventive medications above: Vfend, Noxafil, and Sporanox.

The CDC also advises reducing the dosage of medications that suppress the immune system or discontinuing their use. Someone who has a severe infection may need surgery.

Learn about how to stay healthy with a weak immune system here.

Two older case studies suggest that treatment may prevent the recurrence of fungal infections in people with AML.

A case study reports on the treatment of a Candida infection in a 63-year-old man with AML. At an 11-month follow-up, the man remained free of infection.

In another investigation, combined antifungal therapy was effective in treating a recurrent invasive Aspergillus infection in an 11-year-old boy with AML.

An AML fungal infection occurs because people with cancer have low numbers of the white blood cells that enable the body to fight infections. Doctors refer to this as compromised immunity.

It is important for a person with leukemia to be aware of the signs of a fungal infection and visit their doctor regularly. A prompt diagnosis and early treatment can prevent the spread of the infection. As invasive fungal infections are very dangerous, early treatment may save lives.