Iqbal Humzah, Mehmood Bilal Fazal, Jones Katherine, Sohal Aalam, Roytman Marina
Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA.
Department of Hepatology, Liver Institute Northwest, Seattle, WA, USA.
Transl Gastroenterol Hepatol. 2024 Jun 17;9:49. doi: 10.21037/tgh-24-6. eCollection 2024.
Liver cirrhosis is a chronic condition that is associated with a variety of complications across organ systems. Patients with cirrhosis also suffer from immune dysfunction, which may predispose them to catastrophic bacterial and fungal infections. Bacterial infections in liver cirrhosis have been well-documented, however, data remains scarce regarding fungal infections. and have been reported as the most common pathogens among patients with cirrhosis, causing both invasive and non-invasive infections. However, other pathogens such as , , , and have been increasing in incidence. Diagnosis of fungal infection is often difficult, particularly in regards to distinguishing colonization from invasive infection. Serum markers such as beta-D-glucan (BDG) and galactomannan are beneficial diagnostic tools in conjunction with fungal cultures and imaging modalities. Bronchoscopy with bronchoalveolar lavage (BAL) or lung biopsy can be useful adjuncts as well. Liver transplantation is another important consideration as invasive fungal infection (IFI) is a contraindication to transplant surgery. Additionally, patients are at increased risk for infection due to immunosuppression in the post-transplant period. We aim to discuss the mechanisms responsible for immune dysfunction in advanced liver disease, the epidemiology of fungal infections in this population, as well as presentations and management considerations pertaining to specific pathogens and antifungal regimens.
肝硬化是一种慢性疾病，与多个器官系统的各种并发症相关。肝硬化患者还存在免疫功能障碍，这可能使他们易患严重的细菌和真菌感染。肝硬化患者的细菌感染已有充分记录，然而，关于真菌感染的数据仍然稀少。白色念珠菌和热带念珠菌已被报道为肝硬化患者中最常见的病原体，可引起侵袭性和非侵袭性感染。然而，其他病原体如光滑念珠菌、近平滑念珠菌、克柔念珠菌和新型隐球菌的发病率也在增加。真菌感染的诊断往往很困难，尤其是在区分定植与侵袭性感染方面。血清标志物如β -D-葡聚糖（BDG）和半乳甘露聚糖与真菌培养和影像学检查相结合是有益的诊断工具。支气管镜检查及支气管肺泡灌洗（BAL）或肺活检也可能是有用的辅助手段。肝移植是另一个重要的考虑因素，因为侵袭性真菌感染（IFI）是移植手术的禁忌证。此外，患者在移植后由于免疫抑制而感染风险增加。我们旨在讨论晚期肝病免疫功能障碍的机制、该人群真菌感染的流行病学，以及与特定病原体和抗真菌治疗方案相关的临床表现和管理注意事项。
