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Intra-abdominal fungal infections complicating acute pancreatitis: a review

Guru Trikudanathan1, Udayakumar Navaneethan, Santhi Swaroop Vege

  • 1Department of Internal Medicine, University of Connecticut Medical Center, Farmington, Connecticut, USA.

The American Journal of Gastroenterology
|July 7, 2011
PubMed

Insights

Pancreatic fungal infections (PFI) complicate severe acute pancreatitis (SAP), increasing morbidity. Early diagnosis via fine-needle aspiration and treatment with Amphotericin B, alongside surgical debridement, are crucial for managing this condition.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Intra-abdominal infections, particularly fungal infections of pancreatic necrosis, are a significant complication of severe acute pancreatitis (SAP).
  • The incidence of pancreatic fungal infection (PFI) ranges widely (5%–68.5%), with Candida albicans being the most common pathogen.
  • Risk factors for PFI include prolonged antibiotic use, indwelling devices, and interventions for pancreatic fluid collections.

Purpose of the Study:

  • To review the current understanding of pancreatic fungal infections in severe acute pancreatitis.
  • To highlight diagnostic methods and effective treatment strategies for PFI.
  • To discuss the impact of PFI on patient outcomes.

Main Methods:

  • Review of existing literature on pancreatic fungal infections.
  • Analysis of diagnostic techniques, including computed tomography- or ultrasound-guided fine-needle aspiration.
  • Evaluation of antifungal treatments and surgical interventions.

Main Results:

  • Computed tomography- or ultrasound-guided fine-needle aspiration is a safe and reliable diagnostic method for pancreatic infections.
  • Amphotericin B is considered the most effective antifungal agent.
  • Drainage and debridement of infected necrosis are critical for fungal eradication due to poor drug penetration in necrotic tissue.

Conclusions:

  • Pancreatic fungal infection (PFI) increases morbidity in severe acute pancreatitis (SAP) but does not specifically increase mortality.
  • Prompt diagnosis and aggressive management, including antifungal therapy and surgical debridement, are essential.
  • Further research, including randomized controlled trials, is needed to evaluate the efficacy of antifungal prophylaxis in preventing PFI.

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