INVASIVE ASPERGILLOSIS IN PATIENTS WITH CIRRHOSIS, A CASE REPORT AND REVIEW OF THE LAST 10 YEARS

• Published in: Acta clinica belgica (English ed. Online) 2013-09, Vol.68 (5), p.368-375
• Main Authors: Jeurissen, S, Vogelaers, D, Sermijn, E, Van Dycke, K, Geerts, A, Van Vlierberghe, H, Colle, I
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Aged; Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Cirrhosis; Corticosteroids; Echinocandins - therapeutic use; Humans; Immunocompromised Host; Infections; invasive aspergillosis; Invasive Pulmonary Aspergillosis - diagnosis; Invasive Pulmonary Aspergillosis - drug therapy; Lipopeptides; Liver cirrhosis; Liver Cirrhosis, Alcoholic - complications; Liver Cirrhosis, Alcoholic - drug therapy; Liver diseases; Liver failure; Male; Mortality; Patients; Risk Factors; Stem cells; Tomography, X-Ray Computed; Transplants & implants
• ISSN: 1784-3286; 2295-3337
• DOI: 10.2143/ACB.3408

Background: Untreated invasive aspergillosis (IA) is lethal, yet diagnosis is often delayed. Recognising the risk factors can lead to earlier diagnosis. We present a case of an invasive pulmonary aspergillosis in a patient with cirrhosis, who had been treated with corticosteroids for 2.5 weeks for alcoholic hepatitis. He was successfully treated with liposomal amphotericin B and caspofungin (first in combination, then caspofungin monotherapy). Purpose: to evaluate the role of aspergillosis in cirrhosis Methods: A literature search on aspergillosis in cirrhosis and liver failure patients was conducted in PubMed/ Medline (2002-dec 2012), according to pre-set selection criteria. Results: 20 out of 330 articles were retrieved, representing 43 patients with cirrhosis and/or liver failure who had an aspergillosis infection. Most Aspergillus (A.) infections were due to A. fumigatus and the lungs were the most frequent organ involved (42/43). 58% of the patients used steroids and mortality was 53,5%. The most frequent used antifungal was caspofungin. Discussion: Diagnosis of IA is difficult and there might be a delay in diagnosis since cirrhosis is not recognised as one of the classical risk factors. Mortality was 53,5%, but this is lower than in previous decades. Since voriconazole is hepatotoxic, treatment with caspofungin and /or amphotericin is preferable. Conclusion: Early recognition of aspergillosis in a cirrhosis/ liver failure patient is crucial and should prompt direct treatment.