Spontaneous fungal peritonitis: a rare but severe complication of liver cirrhosis

Gravito-Soares, Marta; Gravito-Soares, Elisa; Lopes, Sandra; Ribeiro, Graça; Figueiredo, Pedro

doi:10.1097/meg.0000000000000927

Cited by 34 publications

(33 citation statements)

References 27 publications

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“…Additional risk factors for acquiring cryptococcal peritonitis in patients with advanced liver diseases include high creatinine levels [ 7 ], recent antibiotic use (eg. SBP prophylaxis) [ 4 , 8 ], high number of invasive procedures [ 2 ], and prolonged hospital stays [ 2 - 3 ]. Prior to developing cryptococcal peritonitis, our patient had a prolonged hospital stay, multiple paracenteses, as well as intermittent Foley placement, broad-spectrum antibiotic administration, and elevated creatinine.…”

Section: Discussionmentioning

confidence: 99%

“…Given the slow culture turnaround time and the modest ascitic fluid pleocytosis, surrogate screening markers for fungal infection should be considered. These include ascitic fluid lactate dehydrogenase (LDH) [ 2 ], serum and ascitic Fungitell (Associates of Cape Cod, Massachusetts, USA) β-d-glucan [ 8 ], and serum and ascitic CrAg [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous peritonitis (SP) is the most common infectious complication among patients with cirrhosis and ascites, occurring in 10%-20% of these patients [ 1 ]. SP is typically caused by bacterial infections (spontaneous bacterial peritonitis or SBP); however, spontaneous peritonitis due to fungal infection (spontaneous fungal peritonitis or SFP) can rarely occur (3%-4% of patients with SP) [ 2 - 3 ]. The Candida species is the most common causative pathogen, occurring in 60%-100% cases of SFP [ 2 - 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…SP is typically caused by bacterial infections (spontaneous bacterial peritonitis or SBP); however, spontaneous peritonitis due to fungal infection (spontaneous fungal peritonitis or SFP) can rarely occur (3%-4% of patients with SP) [ 2 - 3 ]. The Candida species is the most common causative pathogen, occurring in 60%-100% cases of SFP [ 2 - 4 ]. The Cryptococcus species has also been identified as a clinically important cause of SFP that occurs much less frequently [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Cryptic but Deadly: A Serious Killer in Patients with Advanced Liver Disease that Should Not Be Missed

Berinstein

Likhitsup

Vedula

et al. 2017

Cureus

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Cryptococcal peritonitis is an under-recognized disease that is an important cause of mortality in end-stage liver disease. We report a 43-year old male with decompensated cirrhosis secondary to refractory autoimmune hepatitis on immunosuppression with hepatocellular carcinoma who developed cryptococcal peritonitis. The patient subsequently developed ischemic bowel and multisystem organ failure secondary to abdominal compartment syndrome, leading to rapid deterioration and death. Frequently, these patients experience delays in diagnosis and treatment, which leads to a rapid and high mortality. This case report synthesizes data regarding the optimal approach for screening and managing patients with cryptococcal peritonitis and proposes a pathogenic mechanism of mortality with implications for improved treatment in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cryptic but Deadly: A Serious Killer in Patients with Advanced Liver Disease that Should Not Be Missed

Berinstein

Likhitsup

Vedula

et al. 2017

Cureus

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“…These data emphasize the importance of performing fungal cultures and maintaining a high level of suspicion in patients with LC, especially those with impaired renal function and/or receiving antimicrobial treatment with limited clinical response, to ensure early treatment and ultimately reduce mortality (Table 2 )[ 52 - 54 ].…”

Section: Fungal Infections In Lcmentioning

confidence: 99%

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Righi¹

2018

WJG

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Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by Candida spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early post-transplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [e.g., Enterobacteriaceae and Pseudomonas aeruginosa (P. aeruginosa)] and Staphylococcus spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presented.

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Kupffer cell activation by different microbial lysates: Toll‐like receptor‐2 plays pivotal role on thromboxane A₂ production in mice and humans

Zhang¹,

Lin²,

Li³

et al. 2020

Eur J Immunol

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Thromboxane (TX) A 2 has been identified as an important intrahepatic vasoconstrictor upon Kupffer cell (KC) activation during infections such as spontaneous bacterial peritonitis (SBP). The study aimed to investigate the role of TLRs in the TXA 2 increase in liver nonparenchymal cells and their related mechanisms. Here, we identified TLR-2 as a common pathway for different microbials: microbial lysates including Gram-positive bacteria, Gram-negative bacteria, and fungi all increased TXA 2 secretion via activation of TLR-2 in human KCs, accompanied by increased expression and phosphorylation of Myd88related pathway. Of all TLR agonists, only TLR-1,-2, and-4 agonists increased TXA 2 in human KCs. These results were further confirmed by mouse liver nonparenchymal cells. Comparing the effects of TLR-1,-2, and-4 antagonists, only TLR-2 antagonist showed inhibitory effects with all tested microbial lysates. Pretreatment with TLR-2 antagonist in human KCs blocked the secretion of IL-10, CXCL-10, TNF-α, and IL-6 induced by Grampositive and Gram-negative bacterial stimulation. IL-23 and IL-1β were only induced by Gram-negative bacteria. Thus, TLR-2 might be a potential marker and an attractive target for future treatment of patients with SBP. In addition, IL-23 and IL-1β might distinguish early between Gram-positive and Gram-negative SBP.

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Spontaneous fungal peritonitis: a rare but severe complication of liver cirrhosis

Cited by 34 publications

References 27 publications

Cryptic but Deadly: A Serious Killer in Patients with Advanced Liver Disease that Should Not Be Missed

Cryptic but Deadly: A Serious Killer in Patients with Advanced Liver Disease that Should Not Be Missed

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Kupffer cell activation by different microbial lysates: Toll‐like receptor‐2 plays pivotal role on thromboxane A₂ production in mice and humans

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Spontaneous fungal peritonitis: a rare but severe complication of liver cirrhosis

Cited by 34 publications

References 27 publications

Cryptic but Deadly: A Serious Killer in Patients with Advanced Liver Disease that Should Not Be Missed

Cryptic but Deadly: A Serious Killer in Patients with Advanced Liver Disease that Should Not Be Missed

Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions

Kupffer cell activation by different microbial lysates: Toll‐like receptor‐2 plays pivotal role on thromboxane A2 production in mice and humans

Contact Info

Product

Resources

About

Kupffer cell activation by different microbial lysates: Toll‐like receptor‐2 plays pivotal role on thromboxane A₂ production in mice and humans