Intra-abdominal Fungal Infections

Mauricio Rebolledo; Juan C. Sarria

Disclosures

Curr Opin Infect Dis. 2013;26(5):441-446. 

In This Article

Abstract and Introduction

Abstract

Purpose of review The clinical spectrum of intra-abdominal fungal infections has not been systematically analyzed in the literature.

Recent findings Even though intra-abdominal fungal infections have been recognized with increasing frequency in the recent years, most clinical experience is limited to case reports or uncontrolled case series. These infections are more common than clinically recognized disease. The clinical presentation varies broadly depending on the organism and host's immune status, but it is frequently severe, difficult to treat, and associated with significant morbimortality. Predisposing factors, clinical characteristics, and advances in the management are discussed.

Summary Intra-abdominal fungal infections are increasingly important in clinical practice. Early recognition and a combined treatment approach, usually consisting of surgical intervention and systemic antifungal therapy, are required for improved outcomes.

Introduction

Fungi can involve virtually any organ or structure in the abdomen. This involvement is more common than clinically recognized disease. Intra-abdominal fungal infections can be divided into two groups according to their clinical presentation: localized following surgery, trauma, or placement of a foreign device, and disseminated in critically ill or immunocompromised patients. In this review, we discuss the infections caused by Candida, Aspergillus, Mucor, Cryptococcus, Histoplasma, and Coccidioides. It is important to recognize these infections early as serious complications, such as intestinal obstruction, bleeding, perforation, peritonitis, sepsis, and death, can occur. Unfortunately, intra-abdominal fungal involvement is frequently diagnosed late because of its nonspecific presentation. In addition, the presence of multiorgan or extra-abdominal disease may dominate the clinical picture. Diagnosis of almost any form of fungal disease requires an integration of clinical, epidemiological, and laboratory findings. Improvement in microbiologic and serologic techniques now offers the possibility of earlier diagnosis. Definitive diagnosis may require histopathologic evidence of fungal invasion of tissue, but this is not always feasible. Imaging findings, which in the right context may suggest a fungal cause in central nervous system or pulmonary disease, are nonspecific. They may, however, define the extent of disease and aid in surgical planning. Surgical intervention is frequently necessary. The efficacy of antifungal agents has not been evaluated the randomized controlled trials. Most recommendations are based on case reports, uncontrolled studies, and experience gained from other forms of fungal disease. The Infectious Diseases Society of America clinical practice guidelines provide treatment recommendations for different forms of invasive fungal disease (online open-access).[1]

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