Invasive aspergillosis in liver disease patients: no easy way out

Françoise Botterel, Chartier, Daniela Dudau, Nawel Ait-Ammar, Francoise Foulet, Jean-Claude Merle, Eric Levesque


Background: Invasive aspergillosis (IA) has been traditionally considered an infection occurring in
patients with risk factors such as hematologic malignancies or organ transplantation. Recently, there is
increasing evidence that liver disease patients such as severe alcoholic hepatitis or acute hepatic
failure are also at high risk for IA. However, the incidence of IA in this population and its impact on
outcome remain unknown.
Material/methods: Between January 2005 and November 2015, all patients with liver disease
hospitalized in our liver ICU and with Aspergillus spp. in respiratory sample were included in the study.
Clinical and laboratory data were collected retrospectively. Patients were reviewed by a 4 members
team (2 intensive care clinicians and 2 mycologists) and were classified in putative aspergillosis or
colonization with Blot et al. criteria1.
Results: Sixty patients with Aspergillus positive respiratory culture were identified (BAL: n = 52,
bronchial aspirate: n = 3 or sinus sample: n =5), with a median age of 54.5 [21-82] years including 51
male patients. The median MELD score was 27 [6-40]. Cirrhosis was the most common of the liver
disease (n=52, 86%) with cirrhosis decompensation (n = 9) and/or pre-transplant assessment (n = 51).
Aspergillus fumigatus was the most common species of Aspergillus isolated (n = 45, 75%). Seventeen
patients (28%) were diagnosed as putative IA and 43 were considered having Aspergillus colonization.
Direct examination in respiratory samples was positive in 35% of IA group and serum and/or BAL
galactomannan was positive in 35% of IA patients. Aspergillus PCR had not been performed in this
population. Eleven IA occurred in a context of corticosteroids therapy. Curative treatment was given in
50% of all patients. Voriconazole was given in 47 % of IA group versus 23% of colonization group and
caspofungin in 35% and 14%, respectively. The hospital mortality in the IA group was 9/17 (53%)
against 8/43 (18%) in the colonization group.
Conclusions: Systematic screening for IA should be recommended in cirrhotic patients. Nevertheless,
Aspergillus in respiratory tract specimen is common. To treat or not to treat is a difficult question in
cirrhotic patients in whom IA is associated with high mortality and in whom antifungal treatment should
be initiated as soon as possible. Further validation of Aspergillus criteria in cirrhotic patients is needed.
1.Blot SI et al. Am J Respir Crit Care Med. 2012;186:56–64.



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26th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 26th (2016)