Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
BMC Infect Dis. 2024 Mar 22;24(1):345. doi: 10.1186/s12879-024-09226-y.
Aspergillus spp liver abscess is a relatively rare entity and thus far no systematic review has been performed examining patients' demographics, clinical manifestations, diagnosis, management, and outcome.
We performed a systematic review of the literature using MEDLINE and LILACS databases. We searched for articles published in the period from January 1990 to December 24, 2022, to identify patients who developed liver abscesses due to Aspergillus spp.
Our search yielded 21 patients all of whom had invasive aspergillosis confirmed on liver biopsy. Of these patients 81% were adults, and 60% were males. The majority (86%) of patients were immunocompromised and 95% had symptomatic disease at the time of diagnosis. The most common symptoms were fever (79%), abdominal pain (47%), and constitutional symptoms (weight loss, chills, night sweats, fatigue) (38%). Liver enzymes were elevated in 50%, serum galactomannan was positive in 57%, and fungal blood cultures were positive in only 11%. Co-infection with other pathogens preceded development of apsergillosis in one-third of patients, and the majority of the abscesses (43%) were cryptogenic. In the remaining patients with known source, 28% of patients developed liver abscess through dissemination from the lungs, 19% through the portal vein system, and in 10% liver abscess developed through contiguous spread. The most common imaging modality was abdominal computerized tomography done in 86% of patients. Solitary abscess was present in 52% of patients while 48% had multiple abscesses. Inadequate initial empiric therapy was prescribed in 60% of patients and in 44% of patients definite treatment included combination therapy with two or more antifungal agents. Percutaneous drainage of the abscesses was done in 40% of patients, while 20% required liver resection for the treatment of the abscess. Overall mortality was very high at 38%.
Further studies are urgently needed for a better understanding of pathophysiology of liver aspergillosis and for developement of newer blood markers in order to expedite diagnosis and decrease mortality.
曲霉菌属肝脓肿是一种相对罕见的疾病，迄今为止，尚未有系统的综述检查过患者的人口统计学、临床表现、诊断、治疗和预后。
我们使用 MEDLINE 和 LILACS 数据库进行了文献系统综述。我们搜索了 1990 年 1 月至 2022 年 12 月 24 日期间发表的文章，以确定因曲霉菌属而发生肝脓肿的患者。
我们的搜索结果共 21 例患者，所有患者均经肝活检证实为侵袭性曲霉病。这些患者中，81%为成年人，60%为男性。大多数（86%）患者免疫功能低下，95%的患者在诊断时患有症状性疾病。最常见的症状是发热（79%）、腹痛（47%）和全身症状（体重减轻、寒战、盗汗、疲劳）（38%）。50%的患者肝功能升高，57%的患者血清半乳甘露聚糖阳性，仅 11%的患者真菌血培养阳性。三分之一的患者在曲霉菌感染之前合并感染了其他病原体，大多数脓肿（43%）为隐源性。在其余有明确病因的患者中，28%的患者通过肺部播散发展为肝脓肿，19%的患者通过门静脉系统，10%的患者通过邻近传播发展为肝脓肿。最常见的影像学检查方式是腹部计算机断层扫描，86%的患者接受了此项检查。52%的患者有单个脓肿，48%的患者有多个脓肿。60%的患者初始经验性治疗不足，44%的患者明确治疗包括两种或多种抗真菌药物联合治疗。40%的患者接受了脓肿穿刺引流，20%的患者需要肝切除治疗脓肿。总死亡率非常高，为 38%。
迫切需要进一步的研究，以更好地了解肝曲霉病的病理生理学，并开发新的血液标志物，以便加快诊断并降低死亡率。
