Fungal Infection

Although uncommon, fungal disease is seen most within the first 2 months; it can be disseminated and is accompanied by high mortality. Fungal disease can present with multiple organ involvement, peritonitis, fungemia, pneumonitis, or asymptomatic colonization. Ihe incidence of fungal disease is continuing to decrease, but mortality remains high. Mortality is up to 78 percent if disease is systemic. Candida species are responsible for up to 75 percent of fungal illnesses. Ihe diagnosis is by culture or biopsy, and the fungus may be difficult to isolate. Disseminated infection is present when infection is found in two or more sites and is associated with even higher morality. Fungal infection becomes more likely with retransplantation, Roux-en-Y, preoperative steroid use, accompanying vascular complications, the use of three or more intravenous antibiotics, and when the transplant is performed emergently.12 Endemic mycoses (coccidioidomycoses, histoplasmosis, blastomycosis) are always possible in the immunocompromised host but are rarely seen in liver transplant patients. 3

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