Diagnosis and treatment challenges of invasive fungal infections in ICU cirrhosis patients

Abstract

Invasive fungal infections (IFIs) are a serious complication in cirrhotic patients, particularly in intensive care. Cirrhosis-associated immune dysfunction syndrome (CAIDS) and intestinal dysbiosis promote fungal colonization and translocation. Candidemia and invasive aspergillosis are the most common forms, with a high mortality rate reaching 60% and 100% without appropriate treatment. This review examines the mechanisms underlying immune and intestinal changes in cirrhosis that promote fungal infections. It highlights the difficulties of diagnosis with traditional methods that are not very sensitive, and proposes the use of innovative tests (galactomannan, beta-D-glucan, PCR). For fungal infections, echinocandins are recommended as first line treatment for candidiasis and triazoles for aspergillosis. Dosages may be adjusted in the event of hepatocellular insufficiency. Prevention of complications is based on risk assessment, carrying out selective mycological monitoring and initiating quick treatment. Multidisciplinary care and early detection are essential.