Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary Candidiasis

Rupp, Christian; Chahoud, Fadi; Bode, Konrad A.; Wannhoff, Andreas; Friedrich, K; Weiss, KH; Sauer, Pieter; Stremmel, Wolfgang; Gotthardt, D

doi:10.1055/s-0034-1386151

Cited by 3 publications

(6 citation statements)

References 31 publications

(34 reference statements)

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“…Worse prognosis in the late-onset cohort may be in part explained by an increased frequency of infectious complications that could aggravate disease progression. 20 This may be explained by mechanisms of immunosenescence and a subsequently impaired immune response. 21 Although an immunological basis of PSC is obvious 22 and, in many immunological diseases, a late onset is associated with slower disease progression, in late-onset PSC, the course of the disease may be driven more rapidly by repeated or chronic biliary infections.…”

Section: Discussionmentioning

confidence: 99%

Impact of age at diagnosis on disease progression in patients with primary sclerosing cholangitis

et al. 2018

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Background: The median age of diagnosis of primary sclerosing cholangitis (PSC) is $30-40 years. Objective: We aimed to analyse disease progression and liver-dependent survival in patients diagnosed with PSC after 50 years of age. Methods: Patients with PSC were analysed with regard to their age at diagnosis. Patients with a first diagnosis of PSC after the age of 50 years were considered as the late-onset group. Results: A total of 32/215 (14.9%) patients were diagnosed with PSC after 50 years of age. The proportion of females was significantly higher among patients with late-onset PSC (48.4 vs. 27.3%; p ¼ 0.02). Patients with later diagnosis required dilatation therapy more often due to dominant stenosis (84.2 vs. 53.1%; p ¼ 0.01) and suffered from recurrent cholangitis more often (48.3 vs. 21.0%; p ¼ 0.003). Patients with late-onset PSC had reduced transplantation-free survival (10.5 AE 0.6 years vs. 20.8 AE 1.7 years, p < 0.0001), with progredient liver failure and cholangiocarcinoma as the leading causes of death. Conclusions: Patients with later age at diagnosis of PSC displayed a different clinical phenotype with a different sex ratio, immune status and an increased risk for progressive liver failure and biliary malignancies.

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Section: Discussionmentioning

confidence: 99%

Impact of age at diagnosis on disease progression in patients with primary sclerosing cholangitis

et al. 2018

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“…In a follow-up retrospective single centre analysis form Heidelberg, 30 out of 150 (20%) patients had biliary candidiasis. 240 Although all patients demonstrated comparable baseline characteristics, those with persistent biliary candidiasis showed reduced transplantation-free survival along with a markedly elevated frequency of CCA. However, since the advantage of antifungal treatment of biliary Candida is unclear, patients are often not treated for their fungal infection in the absence of an immunosuppressive condition or overt cholangitis.…”

Section: Fungal Infection Candidamentioning

confidence: 93%

“…However, since the advantage of antifungal treatment of biliary Candida is unclear, patients are often not treated for their fungal infection in the absence of an immunosuppressive condition or overt cholangitis. 95,239,240 Risk factors associated with the acquisition of biliary candidiasis were age at PSC diagnosis and number of ERCPs. 240 Moreover, a fucosyltransferase 2 (Fut2) genotype has been identified as a risk factor for high-grade stenosis and biliary Candida infections in PSC.…”

Section: Fungal Infection Candidamentioning

confidence: 99%

“…95,239,240 Risk factors associated with the acquisition of biliary candidiasis were age at PSC diagnosis and number of ERCPs. 240 Moreover, a fucosyltransferase 2 (Fut2) genotype has been identified as a risk factor for high-grade stenosis and biliary Candida infections in PSC. 241 Bacterial cholangitis as a primary indication for liver transplantation Although the simple presence of bacteria in bile does not worsen the outcome if high-grade stenoses are opened endoscopically and infection is adequately treated with antibiotics, 95 the persistence of bacteriobilia may be clinically relevant and greater numbers of bacterial isolates have been associated with a shorter interval to liver transplantation.…”

Section: Fungal Infection Candidamentioning

confidence: 99%

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EASL Clinical Practice Guidelines on sclerosing cholangitis

Chazouillères¹,

Beuers²,

Bergquist³

et al. 2022

Journal of Hepatology

168

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“…Studies related to biliary candidiasis are listed in Table 3. [58][59][60][61][62] Pathogenesis and Risk Factors…”

Section: Epidemiologymentioning

confidence: 99%

Intra-Abdominal Candidiasis

et al. 2017

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Intra-abdominal candidiasis (IAC) is the second most common form of invasive candidiasis after candidaemia. IAC is a broad term and can be classified on the basis of anatomical site (Candida peritonitis, pancreatic candidiasis, biliary tract candidiasis, gastrointestinal candidiasis, and hepatosplenic candidiasis) as well as clinical setting (community acquired versus nosocomial). The risk factors linked with IAC are candida colonisation, anastomotic leak, multiple instrumentation, long-term broad spectrum antibiotic use, total parenteral nutrition, and immunocompromised state. Clinically, IAC is not different from intraabdominal bacterial infection. Patients generally present with signs and symptoms of intra-abdominal sepsis after not responding to antibiotic therapy and with a background history of multiple surgical interventions or history of delayed source control. Radiological investigations, like ultrasonography and computed tomography scan, not only aid in diagnosis but also assist in differentiating medical from surgical cases. Microbiological diagnosis requires isolation of candida from an intra-abdominal specimen. Differentiation between colonisation and infection is difficult. Generally, progressive and persistent colonisation is associated with high risk of infection. Blood cultures have poor sensitivity for IAC. Non-culture based techniques used for diagnosis are mannan/anti-mannan assay, beta-D glucan assay, and validated polymerase chain reaction. Four types of antifungal strategies described in the literature are prophylaxis (risk factor driven), pre-emptive (colonisation or biomarker driven), empirical (fever driven), and targeted therapy (microbiology driven). Over recent years, global epidemiology has shown a shift from Candida albicans to non-albicans. Local epidemiology plays an important role in selection of the appropriate empirical therapy. The purpose of this review is to discuss different types of IAC based on their classification, risk factors, and management.

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Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary Candidiasis

Cited by 3 publications

References 31 publications

Impact of age at diagnosis on disease progression in patients with primary sclerosing cholangitis

Impact of age at diagnosis on disease progression in patients with primary sclerosing cholangitis

EASL Clinical Practice Guidelines on sclerosing cholangitis

Intra-Abdominal Candidiasis

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