Spontaneous Fungal Ascites Infection in Patients with Cirrhosis: An Analysis of 10 Cases

Li, Beiling; Yang, Chao; Qian, Zhiping; Huang, Yan; Wang, Xianbo; Zhong, Guotao; Chen, Jinjun

doi:10.1007/s40121-021-00422-w

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…Furthermore, the gut concentration of TCA is considerably altered in different diseases. Specifically, TCA is highly up-regulated in immunocompromised cancer patients [30][31][32], drug-induced liver injury [33][34][35], high-fat diets [36], and liver cirrhosis [37][38][39][40][41][42], conditions that are associated with severe morbidity and mortality caused by CA. Numerous FDA-approved drugs and probiotics currently used to treat various diseases also profoundly alter bile acid levels, including TCA in the gut [43][44][45][46][47][48][49][50][51][52].…”

Section: Introductionmentioning

confidence: 99%

Bile Acid Regulates the Colonization and Dissemination of Candida albicans from the Gastrointestinal Tract by Controlling Host Defense System and Microbiota

Thangamani

Monasky

Lee

et al. 2021

JoF

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Candida albicans (CA), a commensal and opportunistic eukaryotic organism, frequently inhabits the gastrointestinal (GI) tract and causes life-threatening infections. Antibiotic-induced gut dysbiosis is a major risk factor for increased CA colonization and dissemination from the GI tract. We identified a significant increase of taurocholic acid (TCA), a major bile acid in antibiotic-treated mice susceptible to CA infection. In vivo findings indicate that administration of TCA through drinking water is sufficient to induce colonization and dissemination of CA in wild-type and immunosuppressed mice. Treatment with TCA significantly reduced mRNA expression of immune genes ang4 and Cxcr3 in the colon. In addition, TCA significantly decreased the relative abundance of three culturable species of commensal bacteria, Turicibacter sanguinis, Lactobacillus johnsonii, and Clostridium celatum, in both cecal contents and mucosal scrapings from the colon. Taken together, our results indicate that TCA promotes fungal colonization and dissemination of CA from the GI tract by controlling the host defense system and intestinal microbiota that play a critical role in regulating CA in the intestine.

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Section: Introductionmentioning

confidence: 99%

Bile Acid Regulates the Colonization and Dissemination of Candida albicans from the Gastrointestinal Tract by Controlling Host Defense System and Microbiota

Thangamani

Monasky

Lee

et al. 2021

JoF

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“…Spontaneous fungal peritonitis is a rare, but devastating complication if they remain undiagnosed in cirrhosis patients. 16 For Case 2, the physician initiated antifungal treatment with caution because of the poor liver function and effectively empirical treatment, and did not consider antifungal therapy immediately when the identification of the yeast by mNGS detection. However, during the period of observation, the patient developed to life-threatening meningitis which improved rapidly with antifungal therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Nerveless, our previous study found that patients with bacterascites had poor outcomes and Gram‐positive bacteria were predominant, 15 which may suggest that early microbiological diagnosis for bacterascites, as well as those suspected infected ascites that have absolute neutrophil count less than 250 per cubic millimetre are warranted and mNGS detection may be the supplementary approach. Spontaneous fungal peritonitis is a rare, but devastating complication if they remain undiagnosed in cirrhosis patients 16 . For Case 2, the physician initiated antifungal treatment with caution because of the poor liver function and effectively empirical treatment, and did not consider antifungal therapy immediately when the identification of the yeast by mNGS detection.…”

Section: Discussionmentioning

confidence: 99%

Rapid detection for infected ascites in cirrhosis using metagenome next‐generation sequencing: A case series

Rui

et al. 2021

Liver International

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Empirical antibiotic therapy in patients with spontaneous bacterial peritonitis (SBP) is common as pathogen(s) are identified in only 5%‐20% patients using conventional culture‐based techniques. Metagenome next‐generation sequencing (mNGS) test is a promising approach for the diagnosis of infectious disease. The clinical application of mNGS for infected ascites in cirrhotic patients is rarely reported. Here, we describe three cases to preliminarily explore the potential role of mNGS for microbiological diagnosis of ascites infection in an exploratory manner. The clinical performance of ascites mNGS in cirrhotic patients remains to be further evaluated.

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“…According to the current clinical guidelines, the types of ascites infection in patients with liver cirrhosis can be divided into spontaneous bacterial peritonitis (SBP) and bacterascites [ 2 ]. SBP is a typical type of abdominal infection in liver cirrhosis that occurs in approximately 40% ∼ 70% of cirrhotic patients and plays an important role in the progression of liver cirrhosis, the occurrence of liver-related complications and mortality [ 7 , 8 ]. SBP was defined by polymorphonuclear neutrophil (PMN) count in ascites ≥ 250/mm 3 with positive or negative microbial culture results.…”

Section: Introductionmentioning

confidence: 99%

Application of metagenomic next-generation sequencing in optimizing the diagnosis of ascitic infection in patients with liver cirrhosis

Shi,

Liu,

Liang

et al. 2024

BMC Infect Dis

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Background Metagenomic next-generation sequencing (mNGS) is an emerging technique for the clinical diagnosis of infectious disease that has rarely been used for the diagnosis of ascites infection in patients with cirrhosis. This study compared mNGS detection with conventional culture methods for the on etiological diagnosis of cirrhotic ascites and evaluated the clinical effect of mNGS. Methods A total of 109 patients with ascites due to cirrhosis were included in the study. We compared mNGS with conventional culture detection by analyzing the diagnostic results, pathogen species and clinical effects. The influence of mNGS on the diagnosis and management of ascites infection in patients with cirrhosis was also evaluated. Results Ascites cases were classified into three types: spontaneous bacterial peritonitis (SBP) (16/109, 14.7%), bacterascites (21/109, 19.3%) and sterile ascites (72/109, 66.1%). In addition, 109 patients were assigned to the ascites mNGS-positive group (80/109, 73.4%) or ascites mNGS-negative group (29/109, 26.6%). The percentage of positive mNGS results was significantly greater than that of traditional methods (73.4% vs. 28.4%, P < 0.001). mNGS detected 43 strains of bacteria, 9 strains of fungi and 8 strains of viruses. Fourteen bacterial strains and 3 fungal strains were detected via culture methods. Mycobacteria, viruses, and pneumocystis were detected only by the mNGS method. The mNGS assay produced a greater polymicrobial infection rate than the culture method (55% vs. 16%). Considering the polymorphonuclear neutrophil (PMN) counts, the overall percentage of pathogens detected by the two methods was comparable, with 87.5% (14/16) in the PMN ≥ 250/mm3 group and 72.0% (67/93) in the PMN < 250/mm3 group (P > 0.05). Based on the ascites PMN counts combined with the mNGS assay, 72 patients (66.1%) were diagnosed with ascitic fluid infection (AFI) (including SBP and bacterascites), whereas based on the ascites PMN counts combined with the culture assay, 37 patients (33.9%) were diagnosed with AFI (P < 0.05). In 60 (55.0%) patients, the mNGS assay produced positive clinical effects; 40 (85.7%) patients had their treatment regimen adjusted, and 48 patients were improved. The coincidence rate of the mNGS results and clinical findings was 75.0% (60/80). Conclusions Compared with conventional culture methods, mNGS can improve the detection rate of ascites pathogens, including bacteria, viruses, and fungi, and has significant advantages in the diagnosis of rare pathogens and pathogens that are difficult to culture; moreover, mNGS may be an effective method for improving the diagnosis of ascites infection in patients with cirrhosis, guiding early antibiotic therapy, and for reducing complications related to abdominal infection. In addition, explaining mNGS results will be challenging, especially for guiding the treatment of infectious diseases.

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Spontaneous Fungal Ascites Infection in Patients with Cirrhosis: An Analysis of 10 Cases

Cited by 8 publications

References 22 publications

Bile Acid Regulates the Colonization and Dissemination of Candida albicans from the Gastrointestinal Tract by Controlling Host Defense System and Microbiota

Bile Acid Regulates the Colonization and Dissemination of Candida albicans from the Gastrointestinal Tract by Controlling Host Defense System and Microbiota

Rapid detection for infected ascites in cirrhosis using metagenome next‐generation sequencing: A case series

Application of metagenomic next-generation sequencing in optimizing the diagnosis of ascitic infection in patients with liver cirrhosis

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