Pathogenesis, diagnosis and therapy of Infections complicating patients with chronic liver disease

 
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Annals of Gastroenterology
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2007 (EL)
Pathogenesis, diagnosis and therapy of Infections complicating patients with chronic liver disease (EN)

S.P. Dourakis, V.A. Sevastianos,

Academic Department of Medicine, Hippokration General Hospital, SUMMARY Patients with chronic liver disease represent a susceptible group of the population who manifest numerous complications during the natural course of their disease. As liver disease is considered one of the most common forms of acquired immunodeficiency related to multiple defects in immune defence, infections are one of the main inconveniences associated with high morbidity and mortality. In addition, diagnostic, therapeutic and nursing procedures may influence the critical equilibrium of these patients and predispose to infection. However, the most important predisposed factor is the severity of liver disease and the mortality rate is associated more with the severity than with the etiology of the disease. Infections seen in chronic liver disease include not only spontaneous bacterial peritonitis (SBP) and spontaneous bacterial empyema (SBEM) but urinary tract infections, community or hospital acquired pneumonia, bacteremia, skin and soft tissue infections, endocarditis, and meningitis. Alcoholic subjects are also prone to develop pneumonia and pulmonary or peritoneal tuberculosis. On the other hand, a wide range of infectious sequels, involving almost any organ has been associated with esophageal variceal sclerotherapy (EVS). A significantly shorter series of infectious complications has been related to ligation (EVL). Clinical suspicion of infection should be high in any patient with a deteriorating clinical status, encephalopathy or worsening renal insufficiency, as fever may not present. Since long term prognosis of cirrhotic patients with repeated infectious complications such as SBP and SBEM is poor, survivors should be considered potential candidates for orthotopic liver transplantation. Clinicians’ higher index of suspicion of infection, together with the use of more efficient and safer antibiotics, may, for the present at least improve the short term prognosis of this group of patients. Key words: Chronic liver disease, cirrhosis, spontaneous bacterial peritonitis, spontaneous bacterial empyema, esophageal variceal sclerotherapy, esophageal variceal ligation, other infections (EN)

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Ελληνική Γαστροεντερολογική Εταιρία (EL)
Hellenic Society of Gastroenterology (EN)

2007-03-19


Hellenic Society of Gastroenterology (EN)

1792-7463
1108-7471
Annals of Gastroenterology; Volume 16, No 4 (2003) (EN)



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