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Fungal infection during leukaemia treatment: the warning signs | CION Cancer Clinics
A fever that will not settle on antibiotics, new breathlessness, chest pain on breathing, or swelling or a black patch around the nose during low white counts can mean an invasive fungal infection. Go to the nearest emergency department today or call 108. This page explains why leukaemia treatment raises the risk, which symptoms to watch, how doctors check, and what only your team can tell you. 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, and why does leukaemia treatment raise the risk?
- What symptoms can a fungal infection cause?
- How do doctors check for a fungal infection?
- What do the words on the report mean?
- What do families often believe about fungal infection?
- How is it treated, and what can this page not tell you?
- Common questions about fungal infection during leukaemia treatment
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What to do now
If someone on leukaemia treatment with low white cells has a fever, new breathlessness, chest pain on breathing, coughing up blood, swelling or pain around the nose or eye, or a dark patch inside the nose or on the roof of the mouth, go to the nearest emergency department today or call 108. Say they are on leukaemia treatment with low counts, and take the medicine list. Do not give paracetamol and wait to see if it settles.
The short answer
What is an invasive fungal infection, and why does leukaemia treatment raise the risk?
It is a fungal infection that has spread into the tissues of the body, most often the lungs or sinuses, rather than staying on the skin or in the mouth. It mostly happens when infection-fighting white cells stay very low for a long time, which is common during intensive treatment for acute leukaemia.
Where the fungus comes from
The main culprits are moulds such as Aspergillus and Mucor, whose spores float in ordinary air, dust and soil, and yeasts such as Candida, which already live in the gut and on the skin. A healthy immune system clears them without anyone noticing. When the neutrophils, the white cells that do the clearing, are missing for weeks, a spore can settle and grow.
Why it is taken so seriously
These infections can spread quickly into blood vessels and nearby organs. Early signs are often vague, and a fever may be the only clue at first. Treatment works far better when it starts early, which is why teams look hard for fungus when a fever does not settle on antibiotics.
Preventive antifungal tablets lower the risk but do not remove it. A worrying symptom still needs checking.Not sure whether this applies to you?
Ask an oncologistSymptoms by site
What symptoms can a fungal infection cause?
With low white cells, the body cannot make its usual response, so signs can be milder than the infection. Any of these deserves a same-day call.
Lungs
The most common site. It often starts as a fever that does not come down with antibiotics.
Look out for
- Dry cough or rising breathlessness
- Sharp chest pain when breathing in
- Streaks of blood in phlegm
Sinuses, nose and face
Mould in the sinuses can spread towards the eye and brain, so these signs are urgent even if they seem small.
Look out for
- Blocked nose or pain over the cheek
- Swelling around one eye, or double vision
- A black crust in the nose or on the palate
Blood and central line
Candida can enter the blood, often through a central line. It shows up as fever or chills, sometimes just after the line is flushed, and small raised red spots on the skin.
Liver and spleen
Sometimes a fever returns just as the counts recover, with pain under the right ribs. A scan may show small spots in the liver or spleen.
Finding it
How do doctors check for a fungal infection?
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Fever that does not settle
Low-count fever is first treated with strong antibiotics through a drip. If fever continues after a few days of antibiotics, the team starts looking for fungus.
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CT scan of the chest or sinuses
A CT picks up changes in the lungs that an ordinary X-ray misses. Some patterns point towards mould, but a scan alone does not prove it.
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Blood tests for fungal markers
Galactomannan and beta-D-glucan look for traces of fungus in the blood. A positive result supports the diagnosis. A negative one does not rule it out.
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Samples from the lung or sinus
A bronchoscopy, a camera test into the airways, or a biopsy, a small tissue sample, may be arranged to find the exact fungus. These may be done at a partner centre.
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Treatment often starts before every result is back
When suspicion is high, waiting can do harm, so antifungal treatment through a drip usually begins while tests are still under way.
On your report
What do the words on the report mean?
- Aspergillosis
- An infection caused by Aspergillus mould, most often in the lungs.
- Mucormycosis
- An infection caused by Mucor-type moulds. Many families know it as black fungus. It often affects the sinuses and face.
- Halo sign or nodules
- Patterns on a chest CT that can suggest mould. The doctor reads them with your blood tests and symptoms.
- Probable or possible fungal infection
- Words used when the evidence points towards fungus but no sample has confirmed it yet. Treatment is often given anyway.
- Candidaemia
- Candida yeast found in a blood culture. The central line may need to come out.
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Commonly believed
What do families often believe about fungal infection?
"He is already on an antifungal tablet, so it cannot be fungus."
Preventive tablets lower the risk. They do not bring it to zero, and some moulds are not covered by every tablet. Symptoms still need to be checked the same day.
"The fever came down with paracetamol, so we can wait till morning."
Paracetamol lowers the temperature without treating the cause. With low counts, an infection can move fast overnight. The fever itself is the signal to go.
"Black fungus only happened during Covid."
Mucor moulds existed long before Covid. People with low white cells, on high-dose steroids or with uncontrolled diabetes remain at risk. A black patch in the nose or mouth needs urgent attention.
"A normal chest X-ray means the lungs are clear."
An X-ray can look normal early on. That is why a CT scan is often ordered when a fever will not settle.
Being straight with you
How is it treated, and what can this page not tell you?
Treatment is an antifungal medicine chosen for the likely fungus, usually through a drip at first and often for several weeks. Common choices include voriconazole, isavuconazole, posaconazole and forms of amphotericin B. Surgery to remove dead tissue is sometimes needed for sinus mould.
What happens to the leukaemia treatment
The next block of chemotherapy may be delayed until the infection is under control. That delay is a careful choice by your haematologist, who weighs the infection against the leukaemia. Recovery of the white cells is one of the strongest helps against the fungus.
What this page cannot tell you
It cannot tell you whether a symptom is fungal, how serious an infection is, or how it will turn out. Those depend on the type of fungus, where it is, how quickly counts recover and your general health. Ask your team which fungus is suspected, how it is being confirmed, and what to watch for at home. CION's haematology team reviews each case and coordinates care with qualified centres where specialist tests are needed.
Questions we are asked
Common questions about fungal infection during leukaemia treatment
Is a fungal infection contagious to the family?
No. These infections come from spores in the environment or yeasts already in the body. They do not pass from the patient to healthy family members. You can sit with and care for the person as usual. Wash hands well, mainly to protect the patient from other germs.
How long does treatment usually go on?
Often for weeks, and sometimes for months, at first through a drip and later as tablets. The length depends on the fungus, the site and how quickly the white cells recover. Your haematologist and the infection team decide when it can stop, usually guided by repeat scans.
Why is a CT scan needed when an X-ray was done?
A CT shows much finer detail. Early mould in the lungs can look normal on an X-ray and still show clearly on a CT. Finding it early changes treatment, so a CT is usual when fever continues despite antibiotics.
Can we reduce the risk at home?
Yes, partly. Keep away from building work, dusty rooms, soil, compost and damp walls. Avoid potted plants near the bed. Wear a mask outdoors near construction. Keep blood sugar controlled if there is diabetes. Take any prescribed antifungal exactly as written. None of this replaces urgent care for symptoms.
Will the chemotherapy be stopped completely?
Usually it is paused rather than stopped, until the infection is under control. Many people go on to complete their leukaemia treatment with antifungal medicine continuing alongside. The timing is a decision for your haematologist, based on both the infection and the leukaemia.
Is black fungus the same as this?
Black fungus is the common name for mucormycosis, one type of invasive fungal infection. It often affects the sinuses, face and eye. Aspergillus infection is more common in leukaemia and usually affects the lungs. Both need urgent specialist treatment, and the medicines used are not always the same.
Can children on leukaemia treatment get it?
Yes, especially during intensive phases when counts stay low for a long time. Signs in a child can be vague: a fever that will not settle, fast breathing, or a swollen face. Take the child to the emergency department the same day and tell them about the leukaemia treatment.
Is antifungal treatment expensive, and is it covered?
Some antifungal drips cost a great deal, and the course can be long. Coverage under Aarogyasri, CGHS, ECHS, EHS, PM-JAY and private insurance varies and the rules change, so ask the hospital billing team to check your current entitlement early. Ask too whether an equally suitable, lower-cost option exists.
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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
- American Cancer Society — Infections in people with cancer
- NICE — Neutropenic sepsis: prevention and management in people with cancer (CG151)
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
Antifungal medicine during leukaemia treatmentHow preventive antifungals lower the riskMouth care when white cells are lowEveryday care during the low-count weeksCaring for a central line at homeSigns a line infection needs checkingBlood counts during chemotherapyWhat the white cell numbers on your report mean
Talk to us
Worried about a fever or scan during leukaemia treatment?
For symptoms now, go to the nearest emergency department or call 108. For help understanding the plan afterwards, tell us what has been found so far and we will help you reach the right specialist.