Acute myeloid leukemia (AML) is a cancer of the bone marrow and blood. The two most common fungal infections that affect people with AML are aspergillosis and candidiasis.
Invasive fungal infection is a
Read on to find out how AML lowers resistance to fungal infection, as well as prevention and treatment strategies.
AML is a type of blood cancer. It starts in the bone marrow but usually moves into the blood fairly quickly. It tends to develop from white blood cells that don’t function as they should.
White blood cells are a vital part of the immune system. When a foreign invader like bacteria, virus, or fungus enters your body, white blood cells spring into action. Their job is to attack the invader and prevent illness.
When you have AML, leukemia cells crowd out healthy white blood cells. The production of new white blood cells becomes impaired.
In addition, treatment for AML involves intense chemotherapy, which can also lower your white blood cell count. As a result, the immune system is suppressed and you’re more vulnerable to infection and illness.
Other treatments that can weaken the immune system include:
- radiation therapy
- steroids
- stem cell or bone marrow transplant
Other health problems and nutritional deficiencies can also contribute to the suppression of the immune system.
During cancer treatment, your doctor will monitor your white blood cell count, particularly a type of white blood cell called neutrophils. They’re an important line of defense against infection. If your neutrophil count is low, you have a condition called neutropenia, which increases the risk of infection.
Aspergillus molds and Candida yeasts are the most common fungi to affect people with AML.
Aspergillosis
Aspergillosis is an infection triggered by Aspergillus. It’s a common mold that can be found indoors or outside. Most of us breathe it in every day without cause for concern. But if you have a weakened immune system, you have an increased likelihood of developing the illness.
There are different types of aspergillosis, each causing a different set of symptoms:
- Allergic bronchopulmonary aspergillosis (ABPA): wheezing, shortness of breath, cough
- Allergic Aspergillus sinusitis: runny nose, stuffiness, headache, reduced ability to smell
- Aspergilloma: shortness of breath, coughing, coughing up blood
- Chronic pulmonary aspergillosis: shortness of breath, coughing, coughing up blood, fatigue, weight loss
- Invasive aspergillosis: fever, chest pain, shortness of breath, coughing, coughing up blood
While it’s possible to develop any of these types if you have a weakened immune system, about 10 percent of people with AML develop invasive aspergillosis. This infection most commonly affects the lung.
Candidiasis
Candidiasis is an infection caused by Candida. We all have this yeast on our bodies. It only causes problems when it grows out of control or enters the bloodstream or internal organs.
Different types of candidiasis cause different symptoms:
- Oropharyngeal candidiasis (oral thrush): white patches, redness, soreness, pain, loss of taste, cotton-like feeling in the mouth
- Esophageal candidiasis: pain when swallowing, trouble swallowing
- Vaginal candidiasis (vaginal yeast infection): itching, soreness, pain during intercourse, abnormal discharge, pain when urinating
Invasive candidiasis is a serious infection that can affect many parts of the body. In addition to causing fever and chills, invasive candidiasis can affect the:
- heart
- brain
- blood
- eyes
- bones or joints
Less common fungi
Some less common types of fungi that can also affect people with AML are:
- Acremonium
- C. glabrata
- C. krusei
- Cladosporium
- Cryptococcus
- Fusarium
- Hansenula
- Mucorales
- Penicillium
- Rhodotorula
- Scedosporium
- Trichosporon
- Zygomycetes
Fungi are everywhere, so it’s difficult to completely avoid them. Here are a few things you can do to help lower your risk of infection:
- Wear long sleeves, long pants, and shoes for outdoor activities.
- Use HEPA filters.
- Wear protective gloves if you garden or handle dirt or manure.
- Stay away from construction or excavation sites that can kick up a lot of dust.
- Avoid places that may have a lot of bird or bat droppings.
Prevention and treatment for fungal infections in people with AML require an individualized approach. Even if you show no sign of infection, your doctor may prescribe a prophylactic medication designed to prevent a fungal infection. They include:
- posaconazole (Noxafil)
- fluconazole (Diflucan)
- itraconazole (Onmel, Sporanox)
- voriconazole (Vfend)
- micafungin (Astellas, Mycamine)
- amphotericin B
If you do develop a fungal infection, some drugs above can help treat it. Additional medications used to treat fungal infection are:
- caspofungin (Cancidas)
- micafungin
- anidulafungin (Eraxis)
Fungal infections can recur. That’s why you may need both antifungal therapy and prophylactic therapy until your blood counts improve.
Medications to prevent or treat fungal infections each have potential benefits and risks. The treatment that is best for you depends on a number of factors, such as:
- specific type of fungal infection
- severity of infection
- age, overall health, AML stage
- type of chemotherapy
Symptoms of fungal infections are similar to those of other health conditions. It’s a good idea to get in touch with your doctor whenever you have new or worsening symptoms. While some fungal infections are minor, others can be life threatening.
Untreated, fungal infections can spread to other parts of the body. Getting a quick diagnosis means you can start treatment that may prevent illness. Some signs of fungal infection include:
Fungal infections are not uncommon in people with AML. Both AML and chemotherapy can significantly weaken the immune system, increasing risk for infection. Fungal infections can affect a single organ, such as the lungs or sinuses, or they can affect the bloodstream and multiple organs.
Aspergillosis and candidiasis are the most common fungal infections affecting people with AML.
Fortunately, there are medications to help prevent and treat fungal infections. If you have AML, speak with your doctor about your risk factors and how you can prevent fungal infection.