Invasive aspergillosis in patients with cirrhosis, a case report and review of the last 10 years

BACKGROUND

Untreated invasive aspergillosis (IA) is lethal, yet diagnosis is often delayed. Recognising the risk factors can lead to earlier diagnosis. We present a case of an invasive pulmonary aspergillosis in a patient with cirrhosis, who had been treated with corticosteroids for 2.5 weeks for alcoholic hepatitis. He was successfully treated with liposomal amphotericin B and caspofungin (first in combination, then caspofungin monotherapy).

PURPOSE

To evaluate the role of aspergillosis in cirrhosis.

METHODS

A literature search on aspergillosis in cirrhosis and liver failure patients was conducted in PubMed/Medline (2002-dec 2012), according to pre-set selection criteria.

RESULTS

20 out of 330 articles were retrieved, representing 43 patients with cirrhosis and/or liver failure who had an aspergillosis infection. Most Aspergillus (A.) infections were due to A. fumigatus and the lungs were the most frequent organ involved (42/43). 58% of the patients used steroids and mortality was 53.5%. The most frequent used antifungal was caspofungin.

DISCUSSION

Diagnosis of IA is difficult and there might be a delay in diagnosis since cirrhosis is not recognised as one of the classical risk factors. Mortality was 53.5%, but this is lower than in previous decades. Since voriconazole is hepatotoxic, treatment with caspofungin and/or amphotericin is preferable.

CONCLUSION

Early recognition of aspergillosis in a cirrhosis/liver failure patient is crucial and should prompt direct treatment.

An indicator based 'traffic light' model to pro-actively assess the occurrence of mycotoxins in tree nuts

This paper proposes an indicator based 'traffic light' model as a tool to pro-actively assess the occurrence of mycotoxins in tree nuts. The model is built using a holistic approach and, consequently, uses indicators from inside and outside the tree nut production chain as the basic elements. Temperature and relative humidity (pre-harvest), harvest and drying, storage and transport conditions, crop variety and crop damage were selected as indicators. For these indicators, measurable sub-indicators (model parameters) and risk categories were defined. With these insights, a 'traffic light' model was proposed that indicates the possible risk of occurrence of mycotoxins with colour signals; 'red' indicates high risk, 'yellow' medium risk, and 'green' low risk. The current model is specified for aflatoxins in hazelnuts but can easily be adapted for other mycotoxins and/or tree nuts. Governmental organisations and the commercial sector may use such a model to anticipate on the potential presence of mycotoxins by proactive risk management.

The effects of Peyer's patches inactivation in the rat on the development of antibody-forming cells to intestinal antigen

The effects of Peyer's patch (PP) inactivation on local and systemic immune response in rats was investigated. A cauterization method has been developed to inactivate PP. Animals were primed intraperitoneally or intragastrically with trinitrophenyl-keyhole limpet haemocyanin (TNP-KLH) one day before cauterization, and were challenged intraintestinally two weeks later. The secondary immune response in the spleen, mesenteric lymph node (MLN) and intestinal villi was studied by immunohistochemistry. Histological observations on PP after inactivation showed that most T cells in the interfollicular area had disappeared, as had B cells in the follicle. T cells repopulated PP much slower than B cells. Complete recovery of PP occurred no earlier than 2 weeks after inactivation. The immunization experiments revealed higher numbers of anti-TNP antibody-forming cells (anti-TNP AFC) of IgM, IgG and IgA isotypes in the spleen of the PP-inactivated animals than in the controls. Very few anti-TNP AFC were found locally in the lamina propria of the intestinal villi or in the MLN in both groups. It is suggested that PP play a role in the regulation of systemic immune responses against intestinally-administered thymus-dependent antigen. Moreover, inactivation of PP could alter the antigen uptake by gut epithelium and the local antigen processing. As a result, an increased amount of antigen could reach the spleen eliciting a higher immune response.

New Approach Methodologies (NAMs) for ad hoc human health risk assessment of food and non-food products - Proceedings of a workshop

RIVM convened a workshop on the use of New Approach Methodologies (NAMs) for the ad hoc human health risk assessment of food and non-food products. Central to the workshop were two case studies of marketed products with a potential health concern: the botanical Tabernanthe iboga which is used to facilitate mental or spiritual insight or to (illegally) treat drug addiction and is associated with cardiotoxicity, and dermal creams containing female sex hormones, intended for use by perimenopausal women to reduce menopause symptoms without medical supervision. The workshop participants recognized that data from NAM approaches added valuable information for the ad hoc risk assessment of these products, although the available approaches were inadequate to derive health-based guidance values. Recommendations were provided on how to further enhance and implement NAM approaches in regulatory risk assessment, specifying both scientific and technical aspects as well as stakeholder engagement aspects.

Congener-specific transfer modelling of dioxins and dioxin-like PCBs in free-ranging cattle grazing in the Dutch floodplains

Cattle grazing in the Dutch floodplains are exposed to polychlorinated dibenzo-p-dioxins and dibenzofurans (dioxins) and dioxin-like PCBs (dl-PCBs) through the consumption of grass and adhering soil. This can lead to elevated dioxin and dl-PCB levels in meat fat. To manage this contamination issue, the kinetics of these compounds in cattle need to be better understood. This study describes the development and application of a physiologically based kinetic (PBK) model to predict dioxin and dl-PCB levels in muscle fat of 'Rode Geus' cattle based on measured levels in grass and soil. Calibration of the model was performed separately for each congener, using measured dioxin and dl-PCB levels in various tissues of 14 animals. Model validation performed using dioxin and dl-PCB samples of 14 other cattle, showed that PBK model predictions were on average a factor 2.4 higher than the measured dioxin and dl-PCB TEQ levels in fat. Despite this difference, the model may still be particularly useful to better understand the relation between environmental dioxin and dl-PCB levels and those in cattle. The model is publicly available with a user-friendly interface on www.feedfoodtransfer.nl and may provide relevant insights for risk assessment and risk management.

Contributions of the joint FAO/WHO expert committee on food additives to international food safety: celebrating the 100th meeting of the committee

The Joint FAO/WHO Expert Committee on Food Additives (JECFA) is an international scientific committee that carries out safety and risk assessments on substances that are intended to be added to food or may be present in food. It advises the Codex Alimentarius Commission and the member countries of the Food and Agricultural Organization and the World Health Organization. In 2025, JECFA has its 100th meeting. This paper reviews the work of JECFA since its inception in 1956. The Committee has evaluated over 660 food additives, 105 enzymes, 2500 flavourings, 11 groups of natural toxicants, 12 metals, 25 groups of synthetic chemical contaminants, and residues of 115 veterinary drugs. The Committee has made major contributions internationally on risk assessment methodology for food safety, including the setting of health-based guidance values for chemicals in food, the evaluation of genotoxic and carcinogenic contaminants in food, benchmark dose analysis, use of body burden comparisons, and global approaches to dietary exposure assessment. JECFA advice is independent and based on objective, state-of-the-science assessment of the evidence. Its advice and evaluations are a freely available online resource and play a pivotal role in ensuring the protection of consumer health and enabling the international trade of safe food.