Invasive Aspergillosis in Patients With Cirrhosis, a Case Report and Review of the Last 10 Years

Jeurissen, S E R; Vogelaers, Dirk; Sermijn, Erica; Dycke, K Van; Geerts, Anja; Vlierberghe, Hans Van; Colle, Isabelle

doi:10.2143/acb.3408

Cited by 18 publications

(17 citation statements)

References 33 publications

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“…138 Success with a combination of liposomal amphotericin B and caspofungin was reported in a patient with sAH and probable IA. 169 Pneumocystis pneumonia (PCP) Trimethoprim-sulfamethoxazole (TMP-SMX) is the treatment of choice for PCP. 170 There are limited data on the efficacy of adjunctive corticosteroids for the treatment of PCP in HIV-uninfected patients.…”

Section: Antifungal Treatmentsmentioning

confidence: 99%

Sepsis in alcohol-related liver disease

Gustot

Fernández

Szabó

et al. 2017

Journal of Hepatology

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Alcohol-related liver disease (ALD) remains the most important cause of death due to alcohol. Infections, particularly bacterial infections, are one of the most frequent and severe complications of advanced ALDs, such as alcoholic cirrhosis and severe alcoholic hepatitis (sAH). The specific mechanisms responsible for this altered host defence are yet to be deciphered. The aim of the present study is to review the current knowledge of infectious complications in ALD and its pathophysiological mechanisms, distinguishing the role of alcohol consumption and the contribution of different forms of ALD. To date, corticosteroids are the only treatment with proven efficacy in sAH, but their impact on the occurrence of infections remains controversial. The combination of an altered host defence and corticosteroid treatment in sAH has been suggested as a cause of opportunistic fungal and viral infections. A high level of suspicion with systematic screening and prompt, adequate treatment are warranted to improve outcomes in these patients. Prophylactic or preemptive strategies in this high-risk population might be a preferable option, because of the high short-term mortality rate despite adequate therapies. However, these strategies should be assessed in well-designed trials before clinical implementation.

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Section: Antifungal Treatmentsmentioning

confidence: 99%

Sepsis in alcohol-related liver disease

Gustot

Fernández

Szabó

et al. 2017

Journal of Hepatology

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“…For liver transplant recipients, deep-seated fungal infections, such as invasive aspergillosis (IA), are among the most serious, life-threatening complications. 12) Liver cirrhosis is also a risk factor for IA. 13,14) Hence, prophylactic or targeted therapy for fungal infection is an important strategy in the management of liver transplant recipients.…”

mentioning

confidence: 99%

Necessity for a Significant Maintenance Dosage Reduction of Voriconazole in Patients with Severe Liver Cirrhosis (Child–Pugh Class C)

Yamada

Imai

Koshizuka

et al. 2018

Biological & Pharmaceutical Bulletin

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Therapeutic drug monitoring for voriconazole, an antifungal agent, is essential for maximizing efficacy and preventing toxicity. The aim of this study was to elucidate the optimal maintenance dose of voriconazole in patients with severe liver cirrhosis (Child-Pugh class C) by reviewing the plasma trough concentrations obtained by therapeutic drug monitoring and daily doses of voriconazole. We retrospectively evaluated 6 patients with Child-Pugh class C cirrhosis who received oral voriconazole treatment and were liver transplant recipients or were awaiting liver transplantation. We compared their voriconazole trough concentrations and daily maintenance doses to those of patients who did not have liver cirrhosis (n=56). We found that plasma voriconazole trough concentrations in all patients with Child-Pugh class C were almost within therapeutic range, and the median plasma trough concentration at steady state was not significantly different from that of patients who did not have liver cirrhosis. In addition, the median daily maintenance dose of voriconazole was significantly lower (2.13 mg/kg/d) than that of the control patients (6.27 mg/kg/d), suggesting that trough voriconazole concentrations are elevated in Child-Pugh class C patients. Thus, we conclude that oral voriconazole maintenance doses in patients with Child-Pugh class C should be reduced to approximately one-third that of patients with normal liver function, with the follow-up dose adjusted by therapeutic drug monitoring.

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“…The most frequent cause of morbidity and mortality after LT is not immunological rejection but infectionrelated complications [73][74][75] . Some infections are usually intractable in patients with LC, including bacterial cholangitis [76] , spontaneous bacterial peritonitis [77] , spontaneous bacterial empyema [78] , viral infection [79] , aspergillosis [80] , and Pneumocystis jirovecii pneumonia (formerly known as Pneumocystis carinii pneumonia) [81] . Because the postoperative risk of complications is associated with the pretransplant conditions [82,83] , these infections should be ruled-out and/or treated beforehand.…”

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confidence: 99%

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Hori

Ogura

Onishi

et al. 2016

WJH

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Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation (LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow (PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green (ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination Hori T et al . Peculiar hemodynamics in advanced cirrhosis constant (k ICG) in the well-preserved allograft. The k ICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.

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Invasive Aspergillosis in Patients With Cirrhosis, a Case Report and Review of the Last 10 Years

Abstract: Early recognition of aspergillosis in a cirrhosis/liver failure patient is crucial and should prompt direct treatment.

Cited by 18 publications

References 33 publications

Sepsis in alcohol-related liver disease

Sepsis in alcohol-related liver disease

Necessity for a Significant Maintenance Dosage Reduction of Voriconazole in Patients with Severe Liver Cirrhosis (Child–Pugh Class C)

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

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