Fungal Infections in Acute Myeloid Leukemia

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Yoav Golan, MD, MS, FIDSA, attending physician and associate professor of medicine at Tufts University School of Medicine, Boston, MA, emphasizes the importance of detecting infections of fungal origin in patients with acute myeloid leukemia (AML).

Fungal pathogens are more difficult to treat than bacterial pathogens, due to fewer available antifungal agents and a rising incidence of resistance to existing therapies. Fungal infections are particularly problematic in patients with acute myeloid leukemia (AML), states Yoav Golan, MD. Invasive fungal infections are of the highest concern for patients with AML, as these pathogens tend to be very sticky and materialize poorly in cultures, says Golan.

Autopsy studies have shown that fungal pathogens are more common than expected. In many patients who were found to have disseminated fungal infection, there was no prior suspicion of this diagnosis, and many of those patients were not treated for fungal pathogens. It is imperative for healthcare professionals to remain vigilant for fungal pathogens, checking if patients have any signs, symptoms, or physical findings that could suggest a fungal cause.

The Autopsy Study also revealed that the frequency of some pathogens changes over time. For instance, the frequency of invasive Aspergillus infection has substantially decreased during a 20-year period, while there is a slight increase in the frequency of mucormycosis and no major change in the frequency of invasive Candida. Both aspergillosis and mucormycosis are conditions that result in a very high mortality rate among the AML population, notes Golan.