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Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series

Hélène Prodanovic1, Christophe Cracco, Julien Massard

  • 1Assistance Publique--Hôpitaux de Paris, Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. helene.prodanovic@psl.ap-hop-paris.fr <helene.prodanovic@psl.ap-hop-paris.fr>

BMC Gastroenterology
|February 3, 2007
PubMed
Abstract

Insights

Invasive aspergillosis is a fatal risk for critically ill patients with severe liver failure. Early diagnosis and treatment are crucial for cirrhotic patients presenting with respiratory symptoms and lung opacities.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Hepatology

Background:

  • Invasive fungal infections, particularly invasive pulmonary aspergillosis, are increasingly prevalent in intensive care units.
  • Liver failure is a potential, under-recognized risk factor for invasive aspergillosis.
  • This condition extends beyond immunocompromised patients, affecting critically ill individuals without malignancies.

Observation:

  • Three cases of severe liver failure complicated by adult respiratory distress syndrome, sepsis, shock, and multiple organ failure are presented.
  • Two patients exhibited positive Aspergillus antigenemia, and one had positive Aspergillus serology.
  • Bronchoalveolar lavage confirmed Aspergillus fumigatus in all three cases.

Findings:

  • Despite aggressive treatment with voriconazole and supportive care, all patients experienced fatal outcomes.
  • Aspergillus fumigatus infection poses a significant mortality risk in patients with severe liver failure and critical illness.

Implications:

  • Invasive aspergillosis should be considered in the differential diagnosis of cirrhotic patients with acute respiratory symptoms and alveolar opacities.
  • This highlights the need for heightened clinical suspicion and prompt diagnostic workup for invasive fungal infections in this vulnerable patient population.
  • Further research is warranted to elucidate the mechanisms and improve outcomes for invasive aspergillosis in severe liver failure.

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