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Dumic I, Caetano EM, Domingues SM, Pantic I, Radovanovic M, Prada LR, Nordstrom CW, Antic M, Milovanovic T, Kotseva M, Singh A, Fnu S. Clinical characteristics, diagnosis, treatment, and outcome of patients with liver abscess due to Aspergillus spp: a systematic review of published cases. BMC Infect Dis 2024; 24:345. [PMID: 38519916 PMCID: PMC10960385 DOI: 10.1186/s12879-024-09226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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%. CONCLUSION 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.
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Affiliation(s)
- Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
| | | | | | - Ivana Pantic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Radovanovic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Libardo Rueda Prada
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Jacksonville, Florida, USA
| | - Charles W Nordstrom
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Marina Antic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Tamara Milovanovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Magdalena Kotseva
- Internal Medicine Residency Program, Franciscan Health, Olympia Fields, IL, USA
| | - Amteshwar Singh
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shweta Fnu
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI, USA
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2
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Gündoğdu E, Aydın N. Invasive aspergillosis infection in an immunocompromised patient. Rev Soc Bras Med Trop 2024; 57:e009002024. [PMID: 38324810 PMCID: PMC10852466 DOI: 10.1590/0037-8682-0540-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
- Elif Gündoğdu
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Radiology, Eskişehir, Turkey
| | - Nevin Aydın
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Radiology, Eskişehir, Turkey
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Pourbaix A, Guery R, Bruneau J, Blanc E, Jouvion G, Weinandt M, Rouzaud C, Lourenço J, Boutboul D, Mira JP, Rouquette A, Molina TJ, Lecuit M, Lortholary O. "Chronic Disseminated Aspergillosis," a Novel Fungal Immune Reconstitution Inflammatory Syndrome. Open Forum Infect Dis 2020; 7:ofaa175. [PMID: 33204743 PMCID: PMC7651489 DOI: 10.1093/ofid/ofaa175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 10/22/2020] [Indexed: 01/11/2023] Open
Abstract
We report a case of chronic hepatosplenic aspergillosis following immune reconstitution complicating colic aspergillosis in an AIDS patient with multicentric Castleman disease. Symptoms mimicked the clinical presentation of chronic disseminated candidiasis and responded to corticosteroid. This emerging entity enlarges the spectrum of fungal immune reconstitution inflammatory syndrome in the HIV setting.
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Affiliation(s)
- Annabelle Pourbaix
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Romain Guery
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julie Bruneau
- Pathology Department, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Estelle Blanc
- Nuclear Medicine Department, Marie Lannelongue Hospital, Le Plessis-Robinson, France
| | - Gregory Jouvion
- Pathophysiology of Pediatric Genetic Diseases, Sorbonne Université, INSERM, Assistance Publique Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique Moléculaire, Paris, France.,Experimental Neuropathology Unit, Institut Pasteur, Paris, France
| | - Marthe Weinandt
- Visceral Surgery Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Claire Rouzaud
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Jérémy Lourenço
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - David Boutboul
- Clinical Immunopathology Department, St Louis Hospital, AP-HP, University of Paris, INSERM U967 HIPI, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Alexandre Rouquette
- Pathology Department, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Thierry Jo Molina
- Pathology Department, Necker-Enfants Malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Marc Lecuit
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Biology of Infection Unit, Institut Pasteur, INSERM U1117, Paris, France
| | - Olivier Lortholary
- Paris University, Infectious Diseases and Tropical Medicine Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France
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4
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Fiore M, Cascella M, Bimonte S, Maraolo AE, Gentile I, Schiavone V, Pace MC. Liver fungal infections: an overview of the etiology and epidemiology in patients affected or not affected by oncohematologic malignancies. Infect Drug Resist 2018; 11:177-186. [PMID: 29416363 PMCID: PMC5790101 DOI: 10.2147/idr.s152473] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fungal infections of the liver, most commonly caused by Candida spp., often occur in patients with hematologic malignancies treated with chemotherapy. Colonization of the gastrointestinal tract is thought to be the main origin of dissemination of Candida; mucositis and neutropenia facilitate the spread of Candida from the gastrointestinal tract to the liver. Hepatic involvement due to other fungi is a less common infectious complication in this setting. Fungal infections represent a less common cause of hepatic abscesses in non-oncohematologic population and the trend appears to be decreasing in recent years. Understanding of the etiology and epidemiology of fungal infections of the liver is indicated for an appropriate antimicrobial therapy and an overall optimal management of fungal liver infections.
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Affiliation(s)
- Marco Fiore
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Cascella
- Department of Support for Clinical Activities and Critical Area, Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Sabrina Bimonte
- Department of Support for Clinical Activities and Critical Area, Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Vincenzo Schiavone
- Division of Anesthesia and Intensive Care, Hospital "Pineta Grande", Castel Volturno, Italy
| | - Maria Caterina Pace
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Bernardo RM, Gurung A, Jain D, Malinis MF. Therapeutic Challenges of Hepatic Mucormycosis in Hematologic Malignancy: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:484-9. [PMID: 27406045 PMCID: PMC4948661 DOI: 10.12659/ajcr.898480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Female, 58 Final Diagnosis: Hepatic mucormycosis Symptoms: Abdominal pain • fever Medication: Amphotericin • posaconazole Clinical Procedure: IR-guided aspiration Specialty: Infectious Diseases
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Affiliation(s)
- Raffaele M Bernardo
- Section of Infectious Diseases, Yale University, School of Medicine, New Haven, CT, USA
| | - Ananta Gurung
- Department of Pathology, Yale University, School of Medicine, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University, School of Medicine, New Haven, CT, USA
| | - Maricar F Malinis
- Section of Infectious Diseases, Yale University, School of Medicine, New Haven, CT, USA
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Gjeorgjievski M, Amin MB, Cappell MS. Characteristic clinical features of Aspergillus appendicitis: Case report and literature review. World J Gastroenterol 2015; 21:12713-12721. [PMID: 26640349 PMCID: PMC4658627 DOI: 10.3748/wjg.v21.i44.12713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/13/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologically-proven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified (rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with (1)-neutropenia, (2)-recent chemotherapy, (3)-acute leukemia, and (4)-suspected appendicitis; (5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting anti-Aspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with this proposed pentad may benefit from testing for Aspergillus infection by silver-stains/immunohistochemistry and considering empirical anti-Aspergillus therapy pending a tissue diagnosis.
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