Invasive Fungal Disease

• Candidemia: echinocandin first (caspofungin 70 mg IV load → 50 mg daily); early safe catheter/source control, individualized in neutropenia; daily cultures until 3 consecutive negative days and indicated eye assessment.
• No deep-organ focus: treat ≥14 days from the first persistently negative culture, with symptom/neutropenia recovery; oral step-down requires all stability, clearance, source-control, absorption and susceptibility conditions.
• Invasive aspergillosis: voriconazole is first-line; galactomannan/β-D-glucan plus CT halo sign help in neutropenics.
• Mucormycosis: amphotericin B with urgent surgical debridement; reverse immunosuppression.
• Isavuconazole is an accepted initial alternative for invasive aspergillosis; in mucormycosis liposomal amphotericin remains preferred, with isavuconazole an alternative/step-down option under specialist guidance.

Candidemia / invasive candidiasis

First tests: Blood cultures, Sodium, potassium, bicarbonate, urea and creatinine, Liver biochemistry.

Only if indicated: Serum beta-D-glucan, Culture / histology from a normally sterile site, Targeted evaluation for metastatic infection.

Repeat monitoring: Blood cultures.

Invasive pulmonary aspergillosis

First tests: CT chest.

Only if indicated: Bronchoscopy / BAL, Serum galactomannan, Tissue histology and culture.

Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine, CT chest.