Clinical characteristics and therapeutic analysis of invasive fungal infection in chronic severe hepatitis patients.
OBJECTIVE
To investigate clinical features and antifungal therapeutic effect of chronic severe hepatitis (CSH) patients with invasive fungal infection (IFI), and to improve the diagnosis and treatment.


METHODS
Clinical manifestation, blood routine, imageology and mycetology characteristic, antifungal treatment perscription and therapeutic effect of 79 CSH patients with IFI were retrospectively analyzed. Antifungal therapeutic effect was compared between fluconazole and voriconazole.


RESULTS
Thirteen (16.5%) patients received glucocorticoid or other immunodepressants for a relatively long time, 40 (50.6%) patients had invasive operation, and 61 (77.2 %) patients were administered 1-6 kinds of broad-spectrum antibiotics. Seventy-three patients had fever. Leucocytes and neutrophilic granulocyte increased in 96.2% of the patients. Lung (31.6%), intestinal tract (26.2%) and oral cavity (14%) infections were common. Fungus was found in 70.9% of the patients. Candida albicans (40.9%) and aspergillus (21.1%) were often seen. Halo signs and crescent signs on lung CT were relatively specific in 40% of the patients with fungal pneumonia. Voriconazole was more effective than fluconazole(71.4% vs. 39.0%, P<0.05). Twelve patients with lung aspergillus infection were administered voriconazole, 8 (66.7%) patients of whom was effective, and the other 4 (33.3%) patients died.


CONCLUSIONS
There are high risk factors in major CSH patients with IFI. The most common clinical manifestations of CSH patients with IFI are fever, leukocytosis, lung and intestinal tract infection. Candida albicans and aspergillus infection are common. Voriconazole is more effective than fluconazole, and can increase the survival rate of CSH patients with IFI.
Hou
Zhouhua
Z
Infectious Disease Research Institute, Xiangya Hospital, Central South University, Changsha 410008, China.
Tan
Deming
D
Liu
Guozhen
G
Xie
Yutao
Y
Li
Congzhi
C
Xie
Jianping
J
Lu
Menghou
M
Liu
Zhengbo
Z
Sha
Xinping
X
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006521:Hepatitis, Chronic / Q000150:complications* / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole