Objectives: Liver cirrhosis has recently been described as a risk factor for invasive aspergillosis, particularly in critically ill patients. We determined the clinical presentation and outcome of invasive aspergillosis in patients with liver cirrhosis. Methods: From January 1999 to March 2009, we recorded all proven or probable cases of culturedocumented invasive aspergillosis (EORTC criteria) in patients with liver cirrhosis. Patients with malignancy, solid organ transplantation and chronic obstructive pulmonary disease were excluded. Results: We documented 122 cases of proven or probable invasive aspergillosis and 9 (7%) had of liver cirrhosis. Liver cirrhosis was due to idiopathic autoimmune hepatitis (n = 7), alcoholism (n = 1), and HCV and alcoholism (n = 1). The mean age of the patients was 53.8 y (range 30-79 y) and 6 were male. Overall, 7 patients required admission to intensive care units when invasive aspergillosis was diagnosed. Three patients developed acute liver failure before diagnosis. All patients were receiving corticosteroids and broad-spectrum antibiotics on diagnosis. The disease was always nosocomially acquired and the lung was involved in all patients (one patient also had probable brain involvement, and another probable ocular involvement) with nonspecific radiological findings and bilateral infiltrates. Aspergillus fumigatus was isolated in sputum (n = 2), bronchial aspirate (n = 8), and bonchoalveolar lavage (n = 3). Galactomannan determination was performed in 5 patients and was positive in 4 (=1 ng/mL). Eight patients received antifungal therapy [amphotericin B (n = 2), voriconazole + caspofungin (n = 4), amphotericin B + caspofungin (n = 2)], but only 2 survived (voriconazole + caspofungin). Overall mortality was 77.7% (n = 7). Conclusions: Cirrhotic patients receiving corticosteroids and broad-spectrum antimicrobial agents should be considered potential invasive aspergillosis patients (7% of all cases of invasive aspergillosis in our institution). Lung and extra-pulmonary structures could be involved. The yield of galactomannan was very high. M. Torres-Narbona is contracted by Fondo de Investigacií³n Sanitaria (FIS) CM08/00277. Jesíºs Guinea is contracted by FIS (CA08/00384).
Full conference title:
20th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 20th (2010)