Invasive mycosis in medical intensive care unit patients with severe alcoholic hepatitis.
BACKGROUND
Severe alcoholic hepatitis (AH) has a poor short-term prognosis often caused by infections. However, the incidence of invasive mycosis in patients with AH treated with corticosteroids and its impact still remains unknown.


METHODS
Retrospective analyses of twelve medical ICU patients (out of 120 patients with liver cirrhosis) with histological proven AH.


RESULTS
Twelve patients were diagnosed with histological proven AH during there stay at the ICU. All patients were treated with corticosteroids; three patients were treated with corticosteroids and pentoxifylline. Five patients had invasive aspergillosis (IA); three patients had candidemia; and two had fungal colonization with candida species. Only two patients had no evidence for fungals. IA was associated with death in all cases. Death occured in most cases shortly after diagnosis despite antifungal medication. Two patients with candidemia died; one patient died in the group with fungal colonization. Overall, the mortality rate was 100% in patients with IA and 70% in the group with candidemia.


CONCLUSIONS
Patients with severe AH have an increased susceptibility to invasive mycosis associated with high mortality. A high level of suspicion of invasive mycosis in AH patients and prophylactic strategies are needed in those patients.
II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany, Tobias.Lahmer@lrz.tu-muenchen.de.
Tobias
T
Lahmer
Marlena
M
Messer
Christiane
C
Schwerdtfeger
Sebastian
S
Rasch
Marcel
M
Lee
Bernd
B
Saugel
Roland M
RM
Schmid
Wolfgang
W
Huber
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D005260:Female; D006519:Hepatitis, Alcoholic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones