Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2016; 22(34): 7742-7747
Published online Sep 14, 2016. doi: 10.3748/wjg.v22.i34.7742
Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective
Marco Fiore, Sebastiano Leone
Marco Fiore, Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, 80138 Naples, Italy
Sebastiano Leone, Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, 83100 Avellino, Italy
Author contributions: Fiore M and Leone S have created and mutually revised the paper for final approval.
Conflict-of-interest statement: None of the authors have any conflict of interest in connection with this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sebastiano Leone, MD, Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Contrada Amoretta, 83100 Avellino, Italy. sebastianoleone@yahoo.it
Telephone: +39-825-203967 Fax: +39-825-203967
Received: March 24, 2016
Peer-review started: March 25, 2016
First decision: May 12, 2016
Revised: June 30, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: September 14, 2016
Processing time: 168 Days and 9.2 Hours
Abstract

Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease (ESLD); spontaneous fungal peritonitis (SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients, not even the antifungals used for the prophylaxis, neither optimal treatment. We reviewed, in order to focus the epidemiology, characteristics, and, considering the high mortality rate of SFP, the use of optimal empirical antifungal therapy the current literature.

Keywords: Cirrhosis; Critically ill patient; Spontaneous fungal peritonitis; Life-threatening infections; Fungal ascitis; Nosocomial spontaneous peritonitis

Core tip: Spontaneous bacterial peritonitis (SBP) occurs in patients with end-stage liver disease (ESLD); spontaneous fungal peritonitis (SFP) is a complication of ESLD less known and described. Patients with SFP had a significantly worse prognosis than those with SBP. The incidence accounts from 0% to 13% of patients with ESLD and spontaneous peritonitis. Data are conflicting regarding fungi distribution between nosocomial and non-nosocomial infections. Candida spp. are the most frequent fungal infectious agent isolated. Previous SBP antibiotic prophylaxis, hepatorenal syndrome, low ascitic fluid protein (< 1 g/dL), elevated acute physiology and chronic health evaluation II and serum lactate also significantly adversely impact hospital mortality.