Disseminated Aspergillosis Complicating Hepatic Failure-Reply

Thomas J. Walsh, MD; Stanley R. Hamilton, MD; Leslie L. Walters, MD
Arch Intern Med. 1984;144(4):862. doi:10.1001/archinte.1984.00350160231046.
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In Reply.  —We thank Sesma et al for their comments. Their patient provides evidence that alcoholic hepatitis with cirrhosis may be a predisposing factor for development of invasive aspergillosis. Their patient seemed to have Aspergillus pneumonia as a community-acquired infection, and we agree that corticosteroid therapy in patients with serious liver disease is not a sine qua non for pulmonary aspergillosis. In fact, several factors in patients with liver failure or cirrhosis may be responsible for enhanced susceptibility to invasive aspergillosis, including impaired cell-mediated immunity,1,2 depressed leukocyte hexose monophosphate shunt and phagocytosis-associated metabolic burst activity,3 and possibly the direct effects of alcohol. The use of antibiotics for preceding bacterial infections may also have a role in allowing colonization by Aspergillus.Since the publication of our article4 on disseminated aspergillosis complicating hepatic failure, we have identified at our institution a patient who illustrates another mechanism of increased susceptibility. A


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