title: Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series.
abstract: BACKGROUND
  Opportunistic invasive fungal infections are increasingly frequent in intensive care patients. Their clinical spectrum goes beyond the patients with malignancies, and for example invasive pulmonary aspergillosis has recently been described in critically ill patients without such condition. Liver failure has been suspected to be a risk factor for aspergillosis.
  
  
  METHODS
  We describe three cases of adult respiratory distress syndrome with sepsis, shock and multiple organ failure in patients with severe liver failure among whom two had positive Aspergillus antigenemia and one had a positive Aspergillus serology. In all cases bronchoalveolar lavage fluid was positive for Aspergillus fumigatus. Outcome was fatal in all cases despite treatment with voriconazole and aggressive symptomatic treatment.
  
  
  CONCLUSIONS
  Invasive aspergillosis should be among rapidly raised hypothesis in cirrhotic patients developing acute respiratory symptoms and alveolar opacities.
authors.affiliation: Assistance Publique--Hôpitaux de Paris, Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. helene.prodanovic@psl.ap-hop-paris.fr <helene.prodanovic@psl.ap-hop-paris.fr>
authors.forename: Hélène
authors.initials: H
authors.lastname: Prodanovic
authors.forename: Christophe
authors.initials: C
authors.lastname: Cracco
authors.forename: Julien
authors.initials: J
authors.lastname: Massard
authors.forename: Camille
authors.initials: C
authors.lastname: Barrault
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Alexandre
authors.initials: A
authors.lastname: Duguet
authors.forename: Annick
authors.initials: A
authors.lastname: Datry
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Derenne
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000628:therapy; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D001707:Biopsy, Needle; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D005440:Fluid Therapy; D016469:Fungemia / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D017093:Liver Failure / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology; D012720:Severity of Illness Index
chemical_list: D000935:Antifungal Agents