As cancer patients receive more high-dose chemotherapy treatments and undergo bone marrow transplantation in growing numbers, the opportunities for infections are rising. While a number of antibiotics exist for the prevention and treatment of bacterial infections, using them as preventives often creates a hospitable environment for equally deadly fungal infections -- for which few good treatments now exist.

While people with VHL are not treated with chemotherapy, treatment with radiation therapy, can also result in a temporary weakening of the body's immune system which can put them at risk for such infections.

At the recent International Congress of Chemotherapy, held in Montreal, a number of speakers discussed developments that could improve the diagnosis and treatment of these serious fungal infections in people with weakened immune systems.

Françoise Meunier, M.D., Ph.D., director of the Central Office of the European Organization for Research and Treatment of Cancer in Brussels, said that, while deaths from fungal infections that have spread to the bloodstream are more common in hematolotic malignancies (such as leukemia), even in solid tumors, "5% [of cancer patients who die] have evidence of invasive fungal infection at autopsy." She estimated that 300,000 of the 6 million worldwide cancer deaths each year result from fungal infections that have spread to the bloodstream, also known as fungemia. The more aggressive the treatment, the greater the risk. Some 30% of bone marrow transplant patients show evidence of fungal infection. "It is clearly a catastrophe for a patient to enter a hospital for a bone marrow transplant and then have to explain that this patient is going to die because of invasive Aspergillus."

Meunier said that Aspergillus infection is particularly important to prevent by any means necessary, because there are no good treatments. Prevention of Aspergillus infection may mean something as simple as removing plants from a patient's room (the soil can harbor the fungus) or something as drastic as shutting down an entire bone marrow transplant unit as a result of widespread contamination, which Meunier said was done recently as a unit in France where 21 deaths from invasive Aspergillus occurred. Candida fungus is also a threat.

Elias Anaissie, M.D., associate professor of medicine at the University of Texas M. D. Anderson Cancer Center in Houston, has studied strategies for detecting and preventing fungal growth. While there are drugs which can be administered as preventives, they can permit the growth of other dangerous fungi which do not respond to the preventives. For this reason, preventive drugs are generally given only to patients at high risk, such as those undergoing bone marrow transplant, or patients with acute leukemia and other patients who have prolonged neutropenia. Dr. Anaissie and others are working toward earlier diagnosis of fungal infection. In his own practice, he supervises patients with weekly cultures, and gives preventive treatments if any signs of fungi are found.

Taking drugs such as Decadron can mask the symptoms of fungi. Be alert to signs of infection and report to your doctor without delay. But the best defense remains prevention. People who are being treated with immune-weakening treatments such as radiation and transplantation should decline to accept live plants and flowers in their rooms or homes. They can be put on display at the nurses station, or sent home with a friend. You can suggest that people send cards or balloons or silk flowers instead.

Condensed from "Deadly Fungal Infections Spreading in Cancer Patients," Journal of the National Cancer Institute, 87:19 (October 4, 1995), pp. 1434-1436.

As published in the VHL Family Forum, 4:1, March 1995. For permission to reprint, please contact the VHL Family Alliance, editor@vhl.org. Further information is available from the VHL Family Alliance, info@vhl.org.