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Invasive fungal disease in patients with end-stage liver disease

Yi-Ran Shou1, Zheng-Yin Liu2

  • 1Department of Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100005, China.

Infectious Diseases & Immunity
|July 29, 2026
PubMed

Insights

Invasive fungal disease (IFD) is a growing threat for end-stage liver disease (ESLD) patients due to immune issues and drug resistance. Early diagnosis and tailored antifungal treatments are crucial for better outcomes in this vulnerable group.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Invasive fungal disease (IFD) is a significant and increasing complication in end-stage liver disease (ESLD) patients.
  • ESLD patients exhibit heightened susceptibility to IFD due to immune dysfunction, structural liver changes, and iatrogenic factors.

Purpose of the Study:

  • To review current diagnostic techniques for IFD in ESLD patients.
  • To summarize treatment strategies, considering antifungal drug resistance and hepatotoxicity.
  • To highlight challenges and future research priorities in IFD management for ESLD.

Main Methods:

  • Review of conventional culture-based diagnostic methods.
  • Examination of advanced culture-independent diagnostic techniques, including PCR assays and the T2Candida Panel.
  • Analysis of current treatment guidelines and pharmacokinetic considerations in ESLD.

Main Results:

  • Diagnosis of IFD in ESLD remains challenging despite available methods.
  • Treatment efficacy is often compromised by antifungal hepatotoxicity and emerging drug resistance.
  • Management strategies are stratified by diagnostic certainty but require careful dosing in ESLD.

Conclusions:

  • Optimizing IFD diagnosis and treatment in ESLD patients is critical due to rising prevalence and resistance.
  • Further research is essential to improve management and prophylaxis strategies for IFD in this high-risk population.
  • Addressing diagnostic and therapeutic challenges requires a multi-faceted approach.
Keywords:
Antifungal agentsEnd stage liver diseaseInvasive fungal infections

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