Pneumocystis pneumonia: an opportunistic infection occurring in patients with severe alcoholic hepatitis

Abstract

Chronic alcoholism and alcoholic liver disease are both associated with an important degree of immunosuppression. Corticotherapy, even for a short period, may aggravate this immunodeficiency and predispose these patients to severe opportunistic infections.

Infections complicating severe alcoholic hepatitis:Enterococcusspecies represent the most frequently identified pathogen

“…[16] Opportunistic and fungal infections have been described in patients with AH and were also present in our cohort, indicating impaired host defense. [15,18,19] A multivariate analysis revealed that fungal infections were strongly associated with mortality in AH patients (OR 9.97, p ¼ 0.014), which indicates the need for antimycotic treatment strategies in complicated AH.…”

Invasive aspergillosis in patients with severe alcoholic hepatitis

“…Although corticosteroids improve short-term survival, bacterial infections are observed in 24% of cases during therapy and are associated with a 30% decrease in 2-month survival [3,4]. Moreover, some opportunistic infections, such as Pneumocystis jirovecii and cytomegalovirus infections, are seen in this specific situation [5,6]. Multiple defects in immune defenses are observed in patients with alcohol-induced liver diseases including, impairment of macrophage Fcc-receptor-mediated clearance of antibody-coated bacteria, deficiencies in the complement system, downregulation of monocyte HLA-DR expression, and depressed neutrophil phagocytic and intracellular killing [7].…”

Review article: recent insights into clinical decision‐making in severe alcoholic hepatitis

“…With more severe alcoholic hepatitis, particularly with a prolonged hospital stay and corticosteroid treatment, the possibility of fungal and opportunistic infections should be considered. Pneumocystis pneumonia and invasive mycoses have been described in such patients with a high mortality …”