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Fungal hepatic abscesses: Characterization and management
P A Lipsett1, C J Huang, K D Lillemoe
1Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287-4605, USA.
Summary
Early amphotericin B treatment improves survival in patients with pure fungal or mixed fungal and pyogenic hepatic abscesses. Prompt antimycotic therapy is crucial, especially in immunocompromised individuals, to prevent fatal fungemia.
Area of Science:
- Medicine
- Infectious Diseases
- Hepatology
Background:
- Hepatic abscesses are increasingly diagnosed in immunocompromised patients and those with malignancies.
- Limited data exists on risk factors and treatment for pure fungal and mixed fungal/pyogenic hepatic abscesses.
Purpose of the Study:
- To analyze clinical presentation, diagnosis, management, and outcomes of patients with pure fungal and mixed fungal/pyogenic hepatic abscesses.
- To identify predictors of mortality and evaluate treatment efficacy.
Main Methods:
- Retrospective review of patients with hepatic abscesses at The Johns Hopkins Hospital (1973-1993).
- Analysis of eight patients with pure fungal abscesses and 34 with mixed fungal/pyogenic abscesses.
- Evaluation of clinical data, treatment regimens, and patient outcomes.
Main Results:
- In pure fungal abscesses, fungemia predicted death; early amphotericin B prevented mortality.
- In mixed abscesses, 43% of patients not receiving amphotericin B died.
- Patients receiving >1000 mg amphotericin B had significantly lower mortality.
Conclusions:
- Early amphotericin B treatment is recommended for patients with hematologic malignancies at risk for fungal infections.
- Consider early antimycotic therapy for mixed hepatic abscesses unresponsive to drainage and antibiotics, prior to fungemia.
- Aggressive management with amphotericin B can improve outcomes in fungal hepatic abscesses.