Fungal infection: a common, unrecognised complication of acute liver failure

• Published in: Journal of hepatology Vol. 12; no. 1; pp. 1 - 9
• Main Authors: Rolando, Nancy, Harvey, Felicity, Brahm, Javier, Philpott-Howard, John, Alexander, Graeme, Casewell, Mark, Fagan, Elizabeth, Williams, Roger
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 1991; Elsevier
• Subjects: Acute Disease; Acute Kidney Injury - etiology; Acute Kidney Injury - pathology; Adolescent; Adult; Autopsy; Biological and medical sciences; Candida - isolation & purification; Child; Creatine - blood; Female; Fever - etiology; Fever - pathology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases - pathology; Hemorrhage - etiology; Hemorrhage - pathology; Humans; Incidence; Leukocyte Count; Liver - microbiology; Liver - pathology; Liver Diseases - blood; Liver Diseases - complications; Liver Diseases - microbiology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Mycoses - diagnosis; Mycoses - epidemiology; Mycoses - etiology; Mycoses - mortality; Other diseases. Semiology; Prospective Studies; Prothrombin Time; Infection; Human; Candidiasis; Liver failure; Treatment; Mycosis; Acute; Aspergillosis; Digestive diseases; Diagnosis
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/0168-8278(91)90900-V

The true incidence and clinical relevance of fungal infection was ascertained in a prospective study of 50 consecutive patients with acute liver failure. Fungal infection was present in 16 (32%) patients (15 Candida, one aspergillus) and in seven was considered the major cause of death. All six untreated died, while five of ten patients treated with anti-fungal therapy survived. The diagrusis was made on positive cultures from at least one significant site or on histological evidence of tissue invasion. All 16 hed concomitant bacterial infection and shared features suggestive of a clinical syndrome: deterioration in coma grade after initial improvement; pyrexia unresponsive to antibiotics; established renal failure; and a markedly elevated white cell count. Fungal infection is a common, serious complication of acute liver failure and therapy is indicated for those with positive cultures. A prophylactic trial would be justified in those surviving 5 days, especially, with established renal failure.