Abstract
BackgroundInvasive pulmonary aspergillosis (IPA) is a rapid, progressive, fatal disease that occurs mostly in immunocompromised patients. Patients with severe liver disease are at a heightened risk for infections. Little is known about the clinical presentation including predisposing factors and treatment of IPA in patients with hepatic failure.MethodsMedical records of patients with hepatic failure between November 2005 and February 2007 were reviewed for lung infection. Nine medical records of definitive diagnosis of IPA and three of probable IPA were identified.ResultsThe main predisposing factors were found to be prolonged antibiotic therapy and steroid exposure. Clinical signs and radiological findings were non-specific and atypical. Timely use of caspofungin was found to reduce the mortality due to the disease.ConclusionA high index of suspicion is required for early IPA diagnosis in patients with hepatic failure.
Highlights
Invasive pulmonary aspergillosis (IPA) is a rapid, progressive, fatal disease that occurs mostly in immunocompromised patients
A high index of suspicion is required for early IPA diagnosis in patients with hepatic failure
Examination of the medical records of all 276 patients admitted to Shanghai Public Health Clinical Center with hepatic failure identified 18 patients who had suspected IPA with a negative sputum culture; of these, seven had suspected IPA on admission
Summary
Invasive pulmonary aspergillosis (IPA) is a rapid, progressive, fatal disease that occurs mostly in immunocompromised patients. Patients with severe liver disease are at a heightened risk for infections. Little is known about the clinical presentation including predisposing factors and treatment of IPA in patients with hepatic failure. Pulmonary aspergilloma, allergic aspergillus tracheobronchitis and obstructive bronchial aspergillosis are described. In immunocompromised patients, it can invade the pulmonary parenchyma, resulting in invasive pulmonary aspergillosis (IPA), a disease with high lethality [1,2,3,4]. Little is known about the clinical presentation and treatment of IPA in patients with hepatic failure. The aim of the present study was to determine the clinical presentation and outcome of aspergillosis in patients with hepatic failure. We have analyzed predisposing factors and treatment regimen, in an effort to determine the basis for low mortality in our patient cohort
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