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CION Cancer Clinics
Fungal infection during blood cancer treatment: signs you must not miss | CION Cancer Clinics
Go to the nearest emergency department or call 108 if someone with low counts has a fever that will not settle, a new cough, chest pain, breathlessness, or swelling and dark patches on the face or nose. These can be signs of an invasive fungal infection, which grows fast when white cells are very low. This page explains the warning signs, the tests doctors use, and what to ask. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is an invasive fungal infection?
- Which symptoms can point to a fungal infection?
- What happens when doctors suspect a fungal infection?
- Who is most at risk, and when?
- What do families often get wrong about fungal infection?
- What can this page not tell you?
- Common questions about fungal infection with low counts
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What to do now
If someone on blood cancer treatment has a fever, new chest pain, breathlessness, coughing up blood, a swollen or blackened patch on the face, nose or palate, or sudden confusion, go to the nearest emergency department now or call 108. Say "blood cancer, on treatment, counts may be low". Carry the latest blood report and the list of medicines. Do not wait to see whether it settles overnight, and do not stop or change any medicine on your own first.
The short answer
What is an invasive fungal infection?
It is a fungus growing inside the body's tissues, most often the lungs or sinuses, instead of staying on the skin or in the air. The early signs are easy to miss: a fever that does not settle on antibiotics, a new cough, chest pain, or pain and swelling around the nose and eyes.
Why it happens during blood cancer treatment
Fungal spores are everywhere. They float in dust, building work, damp walls, soil and stored grain. A healthy person breathes them in every day and the white cells clear them. When treatment for leukaemia or another blood cancer keeps the white cell count very low for a long stretch, that defence is gone. The spores can then settle and grow.
The two names you may hear
Aspergillus is the mould doctors think of first. It usually starts in the lungs. Mucor causes mucormycosis, often called black fungus. It usually starts in the nose and sinuses and can spread quickly towards the eye and brain. Each is treated with different medicines, which is why the team works hard to find out which one it is.
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Ask an oncologistRed flags
Which symptoms can point to a fungal infection?
None of these proves a fungal infection. Bacteria and viruses cause most of them. With low counts, any of them needs a doctor the same day.
In the chest
A cough that is new or getting worse, sharp chest pain when you breathe in, or feeling short of breath while resting.
Tell the doctor at once about
- Coughing up blood, even a streak
- Breathlessness that is getting worse
In the nose, face and eyes
A blocked nose on one side, pain or swelling over the cheek, a bloody or dark discharge, or swelling around one eye. These are the early signs of black fungus.
Look closely for
- A black patch inside the nose or on the palate
- Blurred or double vision, or a drooping eyelid
- Numbness of the cheek or face
A fever that will not settle
You are already on strong antibiotics for a fever with low counts, yet the temperature keeps coming back after several days. This is often the first and only clue. Doctors take it seriously even when you feel otherwise stable.
In the head
A severe new headache, confusion, unusual sleepiness, a fit or weakness on one side. These can mean the infection has spread and need emergency care, not a clinic visit.
At the hospital
What happens when doctors suspect a fungal infection?
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Antibiotics and blood cultures first
With a fever and low counts, the team starts antibiotics quickly and takes blood cultures, which are samples grown in the lab to find the germ. They will not wait for a fungal test before acting.
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A CT scan of the chest or sinuses
An ordinary chest X-ray can look normal early on. A CT scan shows small patches in the lung, and a CT of the sinuses shows swelling or bone damage. Certain shapes on the scan make a mould more likely.
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Blood tests for fungus
You may see galactomannan or beta-D-glucan on the request form. These look for parts of the fungal wall in the blood. A positive result supports the idea. A negative one does not rule it out.
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A sample from the affected area
Sometimes a camera test of the lungs, called bronchoscopy, or a small biopsy (a piece of tissue looked at under the microscope) from the nose or skin is needed. For black fungus, an ear, nose and throat surgeon may need to see you urgently.
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Antifungal medicine, often before the proof
Because these infections move fast, the team may start antifungal medicine while tests are still pending. They adjust it once the results come in. Black fungus often also needs surgery to remove dead tissue.
Knowing the risk
Who is most at risk, and when?
The risk is highest when the white cell count stays very low for a long time, not just for a few days. That is why it comes up most with intensive treatment for acute leukaemia, and around stem cell transplant.
Things that raise the risk further
Long courses of steroids weaken the defence against moulds. So does poorly controlled diabetes, which is a strong link with black fungus. Graft-versus-host disease after a donor transplant, and the medicines used to calm it, add more risk. Building work or damp near the home or the ward increases the spores in the air.
When to be most watchful
Be most alert in the stretch when counts are at their lowest after a treatment cycle, and while counts are slowly recovering. Your team can tell you which weeks those are for your own plan. Some patients are given preventive antifungal medicine during this time. Whether that suits you is the haematologist's decision, based on your treatment and your own risks.
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Commonly believed
What do families often get wrong about fungal infection?
"He is on strong antibiotics, so any infection will be covered."
Antibiotics kill bacteria. They do nothing against fungus. A fever that keeps returning despite antibiotics is exactly the pattern that makes doctors look for a fungal cause. Tell the team the moment it happens.
"The chest X-ray was clear, so the lungs are fine."
Early fungal patches are often too small to see on an X-ray. That is why a CT scan is usually asked for when the fever will not settle. Do not refuse or delay the CT because the X-ray looked normal.
"Black fungus only happened during COVID."
Many cases in India were seen at that time, linked to steroids and high sugar. It still occurs today in people with low counts, on steroids or with uncontrolled diabetes. A swollen face or a blocked nose on one side needs the same urgency now.
"Once antifungal medicine starts, he can come home."
These infections usually need close watching in hospital at first, and treatment often goes on for weeks. Going home is decided by the team once the fever, scans and counts are moving the right way, not by how the first few days feel.
Being straight with you
What can this page not tell you?
This page cannot tell you whether a symptom is fungal. Only examination, scans and tests can, and even then doctors sometimes treat on suspicion. It also cannot tell you how an infection will go, because that depends on how soon it is found, which fungus it is, and when the counts recover.
Where CION fits
CION's haematology team, led by Dr. Basudev Pokhrel, reviews the case, discusses it at a tumour board and coordinates care with centres that have the scanning, laboratory and surgical support these infections need. If you are unsure whether a report or symptom is worrying, call and ask. In an emergency, go to the nearest emergency department first.
Never start, stop or change an antifungal or any other medicine without your treating team.Questions we are asked
Common questions about fungal infection with low counts
What is the first sign of a fungal infection with low counts?
Often it is only a fever that does not settle after several days of antibiotics. A new cough, chest pain, or pain and swelling on one side of the face may follow. Because the early signs are vague, tell the team about any fever or new symptom while counts are low, and go to emergency if you cannot reach them.
Can a fungal infection happen without a fever?
Yes. Steroids can hide a fever, and some people show only breathlessness, chest pain, a sinus problem or confusion. Do not use the thermometer as the only guide. If something new and worrying appears while counts are low, get medical help the same day even if the temperature reads normal.
Is it spread from one person to another?
No. These fungi come from the environment, such as dust, soil and damp, not from other people. Family can visit and help care for the patient. Do keep the room clean and dry, avoid building work and potted soil nearby, and follow any mask advice the ward gives.
What does galactomannan on my report mean?
It is a blood test that looks for a piece of the wall of Aspergillus, the most common mould. A positive result supports a mould infection but can be falsely raised. A negative result does not rule one out. Your team reads it alongside your scan and symptoms, never on its own.
How is black fungus different from other fungal infections?
Black fungus, or mucormycosis, usually starts in the nose and sinuses and can spread fast towards the eye and brain. It needs different antifungal medicine from Aspergillus, and often urgent surgery to remove dead tissue. Uncontrolled diabetes and steroids raise the risk. Face swelling or a black patch in the nose is an emergency.
Will the blood cancer treatment be delayed?
It may be. The haematologist weighs the need to control the infection against the need to continue treating the blood cancer. Sometimes treatment pauses, and sometimes it carries on with close watching. This is a decision for your team, and it is fair to ask them to explain the reasons.
How long does antifungal treatment last?
It usually lasts weeks rather than days, and sometimes months. It often starts through a drip in hospital and may later switch to tablets at home. How long depends on the fungus, the scans and whether counts recover. Keep taking it exactly as prescribed until the team tells you otherwise.
Can we lower the risk at home?
Somewhat. Stay away from building sites, dusty rooms, garden soil, compost and stored grain. Fix damp walls if you can. Keep blood sugar controlled. Take any preventive medicine exactly as prescribed. None of this removes the risk entirely, so reporting new symptoms early still matters most.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- NHS — Aspergillosis
- National Cancer Institute — Infection and cancer treatment
- World Health Organization — WHO fungal priority pathogens list
- Macmillan Cancer Support — Cancer information and support
- National Health Mission — National Health Mission
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Neutropenic fever: the emergency to knowWhat to do the moment a fever startsAntifungal protection in acute leukaemiaWhy some patients take preventive antifungal medicineWhich days after treatment are riskiestWhen counts are lowest and infection most likelyCounts, fever and infection in haematologyThe full guide to staying safe with low counts
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Worried about a symptom during treatment?
In an emergency go to the nearest emergency department first. For a report or question, call the helpline and CION's haematology team will help. One helpline serves every CION centre.