Related Experiment Videos
Fungal infection: a common, unrecognised complication of acute liver failure
Abstract:
The true incidence and clinical relevance of fungal infection was ascertained in a prospective study of 50 consecutive patients with acute liver failure. Fungal infection was present in 16 (32%) patients (15 candida, one aspergillus) and in seven was considered the major cause of death. All six untreated died, while five of ten patients treated with anti-fungal therapy survived. The diagnosis was made on positive cultures from at least one significant site or on histological evidence of tissue invasion. All 16 had concomitant bacterial infection and shared features suggestive of a clinical syndrome: deterioration in coma grade after initial improvement; pyrexia unresponsive to antibiotics; established renal failure; and a markedly elevated white cell count. Fungal infection is a common, serious complication of acute liver failure and therapy is indicated for those with positive cultures. A prophylactic trial would be justified in those surviving 5 days, especially, with established renal failure.
Insights
Fungal infections are common in acute liver failure, affecting 32% of patients and causing death in seven. Antifungal therapy improved survival rates, indicating its importance in managing this serious complication.
Area of Science:
- Medicine
- Infectious Diseases
- Hepatology
Background:
- Acute liver failure (ALF) presents significant challenges in patient management.
- The role of fungal infections in ALF mortality is often underestimated.
Purpose of the Study:
- To determine the incidence and clinical significance of fungal infections in patients with acute liver failure.
- To evaluate the impact of antifungal therapy on survival in this patient population.
Main Methods:
- Prospective study of 50 consecutive patients diagnosed with acute liver failure.
- Diagnosis of fungal infection based on positive cultures or histological evidence of tissue invasion.
- Assessment of concomitant bacterial infections and clinical features suggestive of fungal infection.
Main Results:
- Fungal infection was identified in 16 (32%) patients, with Candida species being the most common (15 patients).
- Seven patients with fungal infections were considered to have died due to this complication.
- All six untreated patients died, whereas five of ten treated with antifungal therapy survived.
- Patients with fungal infections often presented with bacterial co-infections and a specific clinical syndrome.
Conclusions:
- Fungal infection is a frequent and serious complication of acute liver failure.
- Antifungal therapy is indicated for patients with confirmed fungal infections.
- Prophylactic antifungal treatment may be warranted for survivors of 5 days, particularly those with renal failure.