A case of pneumonia and sepsis in cirrhosis as paradigm of the problems in the management of bacterial infections in cirrhosis and of the limitations of current knowledge

  • Manuel Tufoni UO Semeiotica Medica, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Italy.
  • Alessandra Tovoli UO Semeiotica Medica, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Italy.
  • Caterina Maggioli UO Semeiotica Medica, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Italy.
  • Lucia Napoli UO Semeiotica Medica, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Italy.
  • Carmen Serena Ricci UO Semeiotica Medica, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Italy.
  • Marianna Mastroroberto SSD Trapianto di Fegato, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola Malpighi, Università di Bologna, Italy.
  • Giacomo Zaccherini UO Semeiotica Medica, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Italy.
  • Paolo Caraceni | paolo.caraceni@unibo.it UO Semeiotica Medica, Dipartimento di Medicina e Chirurgia, Policlinico Sant’Orsola-Malpighi, Università di Bologna, Italy.

Abstract

Bacterial infections are a major problem in the management of liver cirrhosis. They represent the first precipitating cause of death since patients with cirrhosis carry an increased risk of sepsis, sepsis-induced organ failure and death. Although the clinical presentation is often misleading, the presence of bacterial infection should always be actively searched and ruled out with certainty whenever a cirrhotic patient is admitted to the hospital with an acute clinical deterioration. Major changes in the epidemiology of bacterial infections have also occurred in the last decade making the choice of empirical antibiotic therapy a challenge. We report a paradigmatic case of a 54-year old man with hepatitis C-related cirrhosis admitted to the hospital for worsening of his ascites and onset of hepatic encephalopathy, an excellent example for the difficulties of management of sepsis in cirrhosis and the limits of current knowledge.

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Published
2013-09-19
Section
Case Reports
Keywords:
cirrhosis, sepsis, bacterial infection, healthcare related pneumonia, hepatorenal syndrome.
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How to Cite
Tufoni, M., Tovoli, A., Maggioli, C., Napoli, L., Ricci, C. S., Mastroroberto, M., Zaccherini, G., & Caraceni, P. (2013). A case of pneumonia and sepsis in cirrhosis as paradigm of the problems in the management of bacterial infections in cirrhosis and of the limitations of current knowledge. Italian Journal of Medicine, 7(3), 209-214. https://doi.org/10.4081/itjm.2013.209