Fungal infections in severe acute pancreatitis.
J Gastroenterol Hepatol. 2011 Feb 8;
Authors: Kochhar R, Noor MT, Wig J
Severe acute pancreatitis (SAP) is associated with significant morbidity and mortality. Majority of deaths related to SAP are the result of infectious complications. Although bacterial infections are most commonly encountered, fungal infections are increasingly being recognized. Candida is the most common fungal infection. Occurrence of fungal infection in patients with acute pancreatitis adversely affects the clinical course leading to higher incidence of systemic complications and possibly mortality as well. Important risk factors for fungal infection in patients with acute pancreatitis include broad spectrum antibiotics, prolonged hospitalization and surgical/endoscopic interventions, use of total parenteral nutrition, and mechanical ventilation. Patients with higher severity of pancreatitis are at a greater risk. Pathogenesis of fungal infection in patients with acute pancreatitis is multifactorial. Translocation of microorganism across gut epithelium, lymphocyte dysfunction and the virulence of the invading microorganisms play important role. Histological demonstration of fungi remains the gold standard of diagnosis, though role of biomarkers is being investigated as a positive biopsy is rarely obtained. Since early diagnosis and treatment can lead to improved outcome, a high index of suspicion is required for prompt diagnosis. Limiting the use of broad spectrum antibiotics, early introduction of enteral nutrition, and timely change of vascular catheters are important preventive strategies. Role of antifungal prophylaxis remains controversial. Surgical necrosectomy with antifungal therapy is the most widely used treatment approach. In future, clinical trials on antifungal prophylaxis are needed and indications for surgical intervention need to be clearly defined.
PMID: 21299617 [PubMed - as supplied by publisher]