nvasive Aspergillus Peritonitis in Liver Transplant Recipients

ANDRE C. KALIL, MD, ALISON FREIFELD, MD and PETER IWEN,

Author address: 

PhD, Univ. of Nebraska, Omaha, NE

Abstract: 

Peritonitis caused by Aspergillus is a rare disease, with most published cases occurring with peritoneal dialysis. Retrospective analysis of medical and pathology records of liver transplant recipients who had the diagnosis of invasive Aspergillus peritonitis (IAP) from 1988 through 2001.IAP was defined by multiple cultures from the peritoneum with/without positive pathology. Thirtythree liver transplant patients had the diagnosis of invasive aspergillosis (causative agents included Aspergillus flavus [14], A. fumigatus [15], and A. terreus [4]) with 8 of these patients diagnosed with IAP (A. flavus [6], A. fumigatus [1] and A. terreus [1].The median age was 46 (4-60). Five were females and three males. Concomitant transplants included one small bowel, one small bowel and pancreas. One had a second liver. Six patients had the diagnosis of IAP by culture and histopathology and two by multiple cultures. Four of the patients developed disseminated (cultures from two or more sites) aspergillosis, all caused by A. flavus.The most common coinfections were bacterial sepsis (4) and invasive cytomegalovirus disease (3). All patients were receiving steroids, only one patient each was neutropenic or had organ rejection at the time of the diagnosis. Seven patients received debridement and amphotericin B (AMB) in cumulative doses from 118 mg to 1350 mg until cure or death. One patient had wound debridement only and two received itraconazole in addition to AMB. Two patients survived, one received debridment only, the other received debridement, AMB and itraconazole. Both patients had peritonitis based on multiple positive cultures, but only the latter had positive pathology. Even though the median time from admission to initiation of treatment was 4.5 days [1-19], both survivors had treatment started prior to the final culture results on the first day of admission. IPA is an uncommon disease in liver transplant recipients. However, its frequency may be underestimated due to the lack of reliable diagnostics and its high case-fatality rate. Early diagnosis, surgical and anti-fungal therapy are critical to improve the outcome for these patients.
2003

abstract No: 

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Full conference title: 

41st Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 41st