Who Is at Risk for Fungal Diseases

Many fungal diseases that are mild for most people can be life-threatening for people with certain risk factors, and some affect only people with weakened immune systems. The immune system keeps fungi and other germs from attacking the body. People whose immune systems are weakened by illness or medicine are more likely to get fungal diseases, to have severe infections and to recover slowly.

Main risk factors

Medical conditions:

• cancer;
• HIV/AIDS;
• chronic lung disease.

Treatments and medicines:

• long hospital stays;
• stem cell transplants;
• organ transplants;
• corticosteroids;
• high doses of antibiotics.

Particular fungal diseases can have their own risk factors, some unrelated to immunity, such as race, age and pregnancy. Where people live, their work and their access to care also affect risk. CDC has more on fungal infections in people living with HIV/AIDS.

Specific groups

People with cancer. Chemotherapy and radiation destroy cancer cells but can also lower the white blood cell counts the immune system depends on. The type of fungal infection and the level of risk depend on the cancer and the chemotherapy.

Organ transplant recipients take anti-rejection medicines that weaken the immune system so it will not attack the new organ. Small bowel, lung, liver and heart transplants may carry more risk than others.

Stem cell transplant recipients have their immune systems destroyed and rebuilt. Those who receive donor cells face higher risk; like organ recipients they take anti-rejection medicines, and they can develop graft-versus-host disease, in which the transplanted cells attack the body.

Hospital patients usually have weakened immunity while there, from illness, intensive treatment such as chemotherapy, or surgery. Fungi can enter wounds or surgical sites, and devices such as ventilators and catheters can give them a way into the body. Common hospital-acquired fungal infections include invasive candidiasis (especially candidemia), aspergillosis and mucormycosis. The last two have very rarely been linked to mold outbreaks in hospitals, which can start near construction, in contaminated ventilation or through laundry. Candida auris can cause severe, often drug-resistant illness in hospital patients and, unlike other such fungi, spreads easily and often causes outbreaks; patients can shed it onto surfaces around them.

Lowering your risk

Fungi that live in the environment release spores into the air, and exposure cannot always be avoided. It may help to:

• find out whether diseases such as blastomycosis, histoplasmosis or Valley fever are common where you live;
• avoid dusty places such as construction sites, and dust storms;
• wear long pants and long sleeves outdoors;
• in health care settings, learn how to be a safe patient — frequent handwashing matters for patients, visitors and staff.

Talk to a provider

Providers may prescribe antifungal medicine to people at very high risk to prevent infection. Many fungal diseases are misdiagnosed, so if you think you have a fungal infection, or an infection is not getting better with treatment, ask about testing and antifungal treatment.

Sources

• Centers for Disease Control and Prevention: "Risk Factors for Fungal Diseases." The page's illustrations and photographs, which appear to be stock images, are not reproduced.