Invasive mold infections in intensive care in hematological patients.

Abstract

Purpose of review: Invasive mold infections (IMIs) remain a major cause of morbidity and mortality in patients with hematological malignancies, particularly when critical illness develops. Advances in hematological therapies and intensive care medicine have increased the number of high-risk patients admitted to intensive care units (ICUs), where invasive aspergillosis and other mold infections represent important causes of acute respiratory failure and sepsis. This review summarizes current knowledge on IMIs in critically ill hematological patients, focusing on epidemiology, diagnosis, and management.

Recent findings: The epidemiology of IMIs is evolving, with increasing recognition of non-Aspergillus molds, including Mucorales , Fusarium , Scedosporium , and Lomentospora species. Diagnosis in the ICU remains challenging because clinical and radiological findings are often nonspecific and conventional diagnostic criteria may be difficult to apply. Recent advances in imaging, fungal biomarkers, and molecular techniques have improved early detection, while new antifungal agents are expanding therapeutic options.

Summary: IMIs continue to be associated with high mortality in critically ill patients with hematological malignancies. Early diagnosis, prompt initiation of appropriate antifungal therapy, and multidisciplinary management are essential to improve outcomes. Future efforts should focus on ICU-specific diagnostic strategies, risk stratification, and the integration of emerging antifungal therapies.