Invasive aspergillosis in patients with liver disease

Invasive aspergillosis (IA) has been traditionally considered an infection occurring in patients with well established risk factors, such as neutropenia, hematologic malignancies, organ transplantation, or HIV. However there is increasing evidence that apparently immunocompetent patients, such as those with severe liver disease, are also at high risk for Aspergillus infections. Here we report two cases of proven invasive aspergillosis and review 72 others of aspergillosis reported since 1973 in patients with liver disease. Most patients had end-stage cirrhosis or acute hepatic failure. Overall mortality rate was 72.2% and the majority of patients who died had CNS involvement, disseminated infections, and received antifungal agents on a less common basis. A trend toward higher survival for cases reported during the period 2000-2009 was observed. Literature data suggest that invasive aspergillosis is a potential fatal complication of severe liver disease. The high mortality rate observed in these patients appears to be related not only to the severity of their underlying conditions, but also to a lack in clinical diagnosis. New diagnostic tools, e.g., galactomannan (GM) antigen test, in association with increased clinical suspicion may allow an early diagnosis and improve the outcome of IA in this particular category of patients.