Diagnosis And Treatment Of 102 Invasive Fungal Infections In Patients With End-stage Liver Disease

Objectve:Investigating occurance of invasive fungal infections(IFI),clinical features and antifungal therapeutic effect in end-stage liver disease patients,to get better curative effect and prognosis.Methods:Risk factors,clinical manifestation,blood routine,G test,imageology,mycology characteristic,timing and effectiveness of antifungal treatment perscription in 102 end-stage liver disease patients with IFI were retrospectively analyzed.Antifungal therapeutic effect was compared among fluconazole,voriconazole and caspofungin.Result:Among 102 IFI patients,29 cases were diagnosed as proven IFI(4 strains Cryptococcus neoformans,24 strains Candida spp,1 strains Aspergillosis),28 probable cases,45 possible cases.The infectious sites were in abdominal cavity 50 cases,lung 37 cases,blood stream 8cases,the central nervous system 4 cases,both lung and abdominal cavity4 cases,respectively.All the patients were administered 1~2 courses of broad-spectrum antibiotics.Partial patients received glucocorticoid or other immunodepressants for a relatively long time.82 cases had G tests positivebefore antifungal treatment.The clinical features included abdominal distension,ascites difficult to subside,paralytic ileus,weaken diuretic effect,no improvement for liver biochemical marker,even deterioration,etc.Some patients had respiratory symptoms,such as cough,shortness of breath,dyspnea and fever.58 of 102 cases had hairy leukoplakia in oral cavity,and fungi were founded in those stains.58 cases(56.9%)had peripheral blood white cells more than 10×109/L,and 79 cases(77.5%)had neutrophilic granulocyte more than 80 %.29 cases had pulmonary lesions in CT scan.17 patients were administered fluconazole,10 of them(58.8%)were effective,the other 7 patients were invalid;23 patients were administered voriconazole,15 of them(65.2%)were effective,the other 8 patients were invalid;58 patients were administered caspofungin,46 of them(79.3%)were effective,the other 12 patients were invalid.It seemed that caspofungin had the highest rate of effectiveness,but there were no statistic difference among the drugs which might be caused by not enough number cases recruited.Conclusion:There are high risk factors in end-stage liver disease patients which may complicate with IFI.The most common pathogens were Candida spp in these patients.Signs and symptoms of IFI were atypical in the patients with end-stage liver disease.Delayed diagnosis and treatment in patients with these infections may contribute to a high fatality rate.Thus,clinicians should have a high index of suspicion for this unusualbut lethal entity,as prompt detection and appropriate treatment can improve the outcome.Among the drugs available for IFI,caspofungin shows highest effect and safety which can be used in end-stage liver disease patients.