Liver fungal infections

Tinea pedis is a fungal infection commonly known as athlete s foot. Chickenpox is a childhood infection caused by the herpes zoster virus. Hepatitis is a viral infection of the liver. Mumps is a viral infection characterised by bilateral or unilateral inflammation of the salivary glands. Rubella (German measles) is caused by the rubella virus. 

Tollemar J, Hockerstedt K, Ericzon BG, Jalanko H, Ringden O. Liposomal amphotericin-B prevents invasive fungal, infections in liver-transplant recipients—a randomized, placebo-controlled study. Transplantation 1995 59 45-50. 

When 5-FC is prescribed alone to patients with normal renal function, skin rash, epigastric distress, diarrhea, and liver enzyme elevations can occur. When it is prescribed to patients with renal insufficiency or to patients receiving concurrent amphotericin B therapy, blood levels of 5-FC may rise, and bone marrow toxicity leading to leukopenia and thrombocytopenia is common. 5-FC serum levels should be closely monitored in patients with renal insufficiency. Because of baseline leukopenia, 5-FC is often not tolerated by end-stage HIV-infected patients with disseminated fungal infection. 

Nowicki and Bara ska-Rybak (2007) studied the protective effect of shark liver oil. They observed a significant protection against bacterial and fungal infections by shark liver oil treatment which contains mostly squalene and alkylglycerol. Further, this treatment showed improved effects on xerosis and skin lesion-induced atopic dermatitis. This antibacterial and antifungal effect could be accounted for the high-squalene-including composition of the shark liver oil however, detailed studies are needed to be carried out for reputed activity of squalene as an anti-infectant. 

Pneumocystis carini pneumonia (PCP), the most common of the opportunistic infections, occurs in more than 80% of AIDS patients (13). Toxoplasmosis, a protozoan infection of the central nervous system, is activated in AIDS patients when the CD4+ count drops and severe impairment of cell-mediated immunity occurs. Typically, patients have a mass lesion(s) in the brain. These mass lesions usually respond well to therapy and can disappear completely. Fungal infections, such as Cyptococcalmeningitis, are extremely common in AIDS patients, and Histoplasma capsulatum appears when cell-mediated immunity has been destroyed by the HIV virus, leading to widespread infection of the lungs, liver, spleen, lymph nodes, and bone marrow. AIDS patients are particularly susceptible to bacteremia caused by nontyphoidal strains of Salmonella. Bacteremia may be cleared by using antibiotic therapy. 

Dextromethorphan is known to interact with quini-dine and terbinafine. In both cases, there is a reduction in the metabolism of dextromethorphan by the liver. Terbinafine is a drug used to treat fungal infections. Quinidine is used for the treatment of malarial infections and heart rhythm problems. There has been a case report of a drug interaction between the use of fluoxetine (Prozac) and dextromethorphan. Fluoxetine is an antidepressant in the class of drugs called serotonin reuptake inhibitors. 

Organisms other than the viruses discussed earlier can cause acute liver infections, such as Leptospira icterohaemorrhagia, which causes Weil s disease, fungal infections caused by Candida species or aspergillosis, and schistosomiasis caused by trematodes. A number of systemic infections may also affect the liver, leading to jaundice, abnormal liver function tests or even acute liver failure. Table 3.6 lists some of the infective organisms that have been associated with liver disease. 

Rolando, N., Philpott-Howard, J., Williams, R. Bacterial and fungal infection in acute liver failure. Semin. Liver Dis. 1996 16 389-402... 

Mucormycosis of the liver is a rare condition. In one reported case, widespread dissemination of Mucor indi-cus, resulting from isolated ileocoecal mucormycosis with markedly reduced body-own defence, led to liver infection with multiple abscesses. A serious clinical picture with fever, hepatomegaly and icterus developed. The multiple abscesses could be identified by CT and the fungal infection confirmed by microscopic examination or cultures of biopsy specimens. (60-62)... 

Liver infection with Coniothyrium fuckelii in a female patient with leukaemia was reported for the first time in 1987. (65) The acute clinical picture consisting of fever, arthralgia and myalgia, nightly sweats, increased inflammatory parameters and enhanced alkaline phosphatase could be identified, after extensive examination, as a fungal infection of the liver. Histology revealed focal, partly granulomatous inflammatory lesions, from which C. fuckelii was demonstrated by culture. 

Wade JJ, Rolando N, Hayllar K, Philpott-Howard J, Casewell MW, Williams R. Bacterial and fungal infections after liver transplantation an analysis of 284 patients. Hepatology 1995 21(5) 1328-36. 

Focal nodular hyperplasia of the liver has been reported in a 38-year-old woman who had taken itraconazole 200 mg/day for 4 months for a fungal infection of the fingernails (37). She had taken no other drugs in the year during which focal nodular hyperplasia developed. 

Winston DJ, BusuttU RW. Randomized controlled trial of oral itraconazole solution versus intravenous/oral fluconazole for prevention of fungal infections in liver transplant recipients. Transplantation 2002 74(5) 688-95. 

Fungal infections are divided into superficial or deep-seated infections. Superficial infections affect the skin, nails or mucosal surfaces of the mouth or genital tract. In contrast, deep-seated fungal diseases may target the lung or disseminate via the bloodstream to organs such as the brain, spleen, liver or skeletal system. 

Ketoconazole produces generalized hepatocellular necrosis or milder forms of hepatic dysfunction in 1% to 2% of patients treated for fungal infections. This reaction is fatal in high numbers of patients infected with the human immunodeficiency virus. The onset is usually early in therapy, although it can be delayed until several months into therapy. In rmmune-compromised patients in whom ketoconazole is used for long periods of time, special care should be taken to watch for changes in liver function. ... 

Systemic fungal infections are a major cause of morbidity and mortality in the immunocompromised patient. Fungal infections account for 20% to 30% of fatal infections in patients with acute leukemia, 10% to 15% of fatal infections in patients with lymphoma, and 5% of fatal infections in patients with solid tumors. The frequency of fungal infections among transplant recipients ranges from 0% to 20% for kidney and bone marrow transplant recipients to 10% to 35% for heart transplant recipients and 30% to 40% for liver transplant recipients. ... 

A 68-year-old woman who had been taking leflunomide 10 mg daily for about 4 months was started on itraconazole 300 mg daily for a fungal infection. About one month later her leflunomide dose was increased to 20 mg daily, and liver function tests were normal. The following month, she developed abdominal pain, vomiting, and weakness. Despite symptomatic treatment and washout with colestyramine, fatal fulminant hepatic failure occurred. The authors of the report attribute the reaction to additive hepatotoxicity between the leflunomide and itraconazole. This interaction serves to highlight the cautions about the use of other hepatotoxic drugs, see (a) and (h). 

Fungal infections of the liver are very rare in normal patients. They are more typically seen in immunocompromised patients secondary to chemotherapy or AIDS-HIV. 

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