Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality in patients with hematological malignancies. Several factors including the underlying disease, immunosuppressive drugs and neutropenia contribute to the compromised immune systems. Aspergillus, Candida, and Mucorales  are the most common pathogens associated with infections in these populations. Mortality rates for IFIs are substantial, with invasive aspergillosis reaching 30-50% and mucormycosis exceeding 60-90%, especially in severely immunocompromised pat

Factors contributing to high mortality include delayed diagnosis, the pathogen’s resistance to antifungal treatments, and prolonged or severe immunosuppression. Early and appropriate antifungal therapy is critical for survival, but challenges remain due to non-specific symptoms and limited diagnostic tools. Antifungal resistance, especially in Candida and Aspergillus species, further complicates treatment, with azole-resistant strains reducing the effectiveness of standard therapies.

Morbidity in these patients includes prolonged hospitalization, the need for ICU care, and long-term antifungal therapy, sometimes with significant toxicities. Surgical interventions for infections like mucormycosis can be life saving if done early in the disease. This is further complicated by scarcity of data on testing and reporting of antifungal drugs, emergence of drug resistant esoteric fungal infections as well as lack of efficacy data on newer antifungal drugs.

Improved early diagnostic methods both culture based and non culture based including Galactomannan, beta D Glucan are the need of the hour. Rapid identification with the new MALDI software, increasing training in morphology of fungal pathogens, antifungal prophylaxis, personalized treatment strategies can lead the future of invasive fungal infection management.

Dr Ruchika Gupta is Assistant Professor at Schulich school of Medicine and Dentistry. She is trained in Transplant Infections as well as Medical microbiology from University of Toronto. Antimicrobial resistance, diagnostic stewardship, fungal infections and infections in the immunocompromised host are the key areas of interest.