Spontaneous fungal peritonitis: a severe complication in patients with advanced liver cirrhosis

Abstract

Treatment of cirrhotic patients with spontaneous peritonitis using antibiotics occasionally fails. Fungal infections may be one of the causes of antibiotic treatment failure in such patients. In this study we evaluated the clinical significance and characteristics of spontaneous fungal peritonitis (SFP). Consecutive cirrhotic patients with spontaneous peritonitis treated between 2000 and 2005 at a tertiary care center in Seoul, Korea, were included. We analyzed the clinical characteristics and the prognosis of SFP patients compared with patients with spontaneous bacterial peritonitis (SBP). During the study period 416 patients developed spontaneous peritonitis and 15 (3.6 %) had SFP. Compared with patients with SBP, nosocomial peritonitis (peritonitis that developed after hospitalization for >72 h) was more common and the Child-Pugh score was higher in SFP patients (both, P < 0.01). Ten patients were infected with Candida spp. (C. albicans, 8; C. tropicalis, 1; C. glabrata, 1), and 5 with Cryptococcus neoformans. Eleven patients were co-infected with bacteria that were susceptible to the antibiotics administered. Only 5 patients were treated using appropriate anti-fungal agents. The 1-month mortality rate for SFP patients was 73.3 % (11 out of 15; median time to death, 2 days [range, 0-22]), which was significantly higher than patients with SBP alone (28.7 %, P = 0.0007). SFP is severe complication related to high mortality in cirrhotic patients. A longer admission and a higher Child-Pugh score may be risk factors. Immediate anti-fungal treatment is warranted in patients with spontaneous peritonitis, once fungus is found in the ascitic fluid.

Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit

“…Spontaneous bacterial peritonitis is one of the most common infections in patients with cirrhosis. In a study of 416 patients with culture-positive spontaneous bacterial peritonitis there were 15 (3.5%) cases of fungal peritonitis [15]. The main species were Candida albicans and Cryptococcus neoformans.…”

Intestinal fungi contribute to development of alcoholic liver disease

“…Patients with cirrhosis frequently either are exposed to fungal products (12) or develop fungal infections, with high mortality (13)(14)(15). Spontaneous fungal peritonitis is mainly caused by Candida species -in particular by Candida albicans in patients with cirrhosis (16).…”

Letter: what else can improve survival in cirrhotic patients with spontaneous bacterial peritonitis and associated septic shock? Authors’ reply

“…5 Finally, our high (100%) mortality rate in fungal peritonitis/shock is consistent with other studies. 6 Prior studies have shown that directed anti-fungal therapy did not improve patient outcomes. 7 Hence, fungal peritonitis may potentially be a poor prognostic marker.…”