The Spectrum of Hepatic Candidiasis

Abstract

The liver is affected in up 50 to 75% of compromised hosts with disseminated Candida albicans infection who come to autopsy. The antemortem diagnosis of hepatic candidiasis is rarely made. Blood cultures are negative in approximately 50% of cases, and biochemical parameters of hepatic injury may be of nonspecific value. Additionally, the more commonly seen renal, cardiac, and respiratory involvement may overshadow the hepatic lesion. In a review of 17 autopsy series of disseminated candidiasis, 92 cases with hepatic involvement were identified for a mean prevalence of 13.7%. Hepatic granulomas and microabscesses were the two most common histologic lesions attributable to Candida. Inflammatory aggregates, centrilobular congestion, bile stasis, and fatty change were seen less frequently. The diagnosis should be suspected in any compromised host with unexplained fever with or without elevated alkaline phosphatase or bilirubin levels. The diagnosis can be made by percutaneous needle biopsy or at laparoscopy in a majority of cases. Early treatment with Amphotericin is associated with prolonged survival.

Biliary candida infections in primary sclerosing cholangitis

“…It seems obvious that in all patients with clinical evidence of cholangitis and in those with endoscopic interventions in especial, bile samples obtained after selective intubation of the bile duct should be subjected to microbiologic examination. The antifungal treatment of patients with cholangitis and biliary tract Candida has been recommended repeatedly [12,25,26]. Whether and how patients with PSC and biliary Candida infection will benefit from antifungal treatment is unclear at present.…”

The Prometastatic Microenvironment of the Liver

“…Second, the liver also contains a large resident population of activated defense cells—including macrophages [ 13 ], dendritic cells [ 14 ], mast cells [ 15 ], cytotoxic natural killer (NK) cells and T lymphocytes [ 16 ]—that provide an enhanced innate immune response, while are maintaining a tolerogenic state to avoid chronic inflammation [ 17 , 18 ]. In turn, hepatic immune tolerance may be responsible for the increased prevalence of autoimmunity, infectious diseases and malignancies, because the hepatic territory does not significantly object the implantation and growth of microorganisms—as for example malaria sporozoites [ 19 ], fungi [ 20 ], progenitor hematopoietic cells [ 21 ], and even cancer cells. Third, the liver contains a heterogeneous population of parenchyma cells—hepatocytes and cholangiocytes—and non-parenchymal stromal cells—mainly portal fibroblasts and perisinusoidal stellate cells— [ 22 , 23 ].…”

Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature

“…It is believed that the prolonged course of fever observed in these patients is due to immune reconstitution inflammatory syndrome associated with invasive fungal infections, as has been described in patients with human immunodeficiency virus infection or those who have undergone solid organ transplantation, rather than treatment failure. The time for resolution of fever has exceeded 4 weeks in some reports and cumulative data suggest that a median of at least 15 days is required before resolution (2, 5, 16, 31–33). Our patient had continuous fever during the first few weeks of antifungal therapy without any radiographic progression of hepatosplenic abscesses.…”