title: Hospital-acquired invasive pulmonary aspergillosis in patients with hepatic failure.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) is a rapid, progressive, fatal disease that occurs mostly in immunocompromised patients. Patients with severe liver disease are at a heightened risk for infections. Little is known about the clinical presentation including predisposing factors and treatment of IPA in patients with hepatic failure.
  
  
  METHODS
  Medical records of patients with hepatic failure between November 2005 and February 2007 were reviewed for lung infection. Nine medical records of definitive diagnosis of IPA and three of probable IPA were identified.
  
  
  RESULTS
  The main predisposing factors were found to be prolonged antibiotic therapy and steroid exposure. Clinical signs and radiological findings were non-specific and atypical. Timely use of caspofungin was found to reduce the mortality due to the disease.
  
  
  CONCLUSIONS
  A high index of suspicion is required for early IPA diagnosis in patients with hepatic failure.
authors.affiliation: Shanghai Public Health Clinical Center affiliated to Fudan University, Shanghai, 210508, PR China. lidan@shaphc.org
authors.forename: Dan
authors.initials: D
authors.lastname: Li
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.forename: Xian
authors.initials: X
authors.lastname: Ding
authors.forename: Ran
authors.initials: R
authors.lastname: Tao
authors.forename: Yong Xin
authors.initials: YX
authors.lastname: Zhang
authors.forename: Jie Fei
authors.initials: JF
authors.lastname: Wang
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000139:chemically induced / Q000150:complications* / Q000401:mortality; D000077336:Caspofungin; D015331:Cohort Studies; D003428:Cross Infection / Q000139:chemically induced / Q000150:complications* / Q000401:mortality; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D055666:Lipopeptides; D017093:Liver Failure / Q000150:complications*; D008172:Lung Diseases, Fungal / Q000139:chemically induced / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D013256:Steroids; D000077336:Caspofungin